Grasper with magnetically-controlled positioning

ABSTRACT

Devices, systems, and methods for providing remote traction to tissue may include a grasper and a control element. The grasper may have a first jaw, a second jaw, a main body, and a first magnetic element. The control element may include a second magnetic element. The first and second magnetic elements may attract the grasper to the control element such that the grasper is oriented parallel, perpendicularly, or at an angle between parallel and perpendicular with respect to the control element and/or a body. In some instances, the grasper may include first and second magnetic elements and the control element may include third and fourth magnetic elements.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.15/728,302, filed on Oct. 9, 2017, and titled “GRASPER WITHMAGNETICALLY-CONTROLLED POSITIONING,” now U.S. Pat. No. 10,905,511,which is a continuation filed under 35 U.S.C. § 120 of InternationalApplication No. PCT/US2016/027390, filed Apr. 13, 2016, and titled“GRASPER WITH MAGNETICALLY-CONTROLLED POSITIONING,” which designated theUnited States and which claims priority to U.S. Provisional ApplicationSer. No. 62/146,922, filed on Apr. 13, 2015, and titled “GRASPER WITHMAGNETICALLY-CONTROLLED POSITIONING,” and to U.S. ProvisionalApplication Ser. No. 62/276,752, filed on Jan. 8, 2016, and titled“ONE-OPERATOR SURGICAL SYSTEM,” the content of each of which is herebyincorporated by reference in its entirety.

FIELD

The present invention is directed toward systems, devices, and methodsfor providing remote manipulation or traction to tissue using one ormore graspers.

BACKGROUND

Many surgical procedures are shifting toward the use ofminimally-invasive approaches that are configured to minimize the numberand size of incisions that are made in a patient. Minimally-invasiveprocedures such as endoscopic and laparoscopic procedures may beassociated with lower pain, quicker post-surgical recovery, shortenedhospitalization, and reduced complications when compared to opensurgical procedures. During minimally-invasive procedures it may bedesirable to reposition or otherwise manipulate tissue, however theintroduction of additional devices to engage tissue may crowd the accesssites provided by incisions, which may require the formation of largeror additional access sites. Accordingly, it may be desirable to provideone or more devices that may rotate, retract, pull, reposition, orotherwise manipulate tissue without the need to have a portion of thedevice present in an access site to the body.

BRIEF SUMMARY

Described here are systems, devices, and methods for providing remotetraction for tissue. In some variations, the systems described here maygrasp tissue. The systems may comprise a grasper comprising a proximalend, a distal end, and a longitudinal axis. The grasper may comprise afirst magnetic element at the proximal end. The systems may furthercomprise a control element configured to move at least a portion of thegrasper. The control element may comprise a second magnetic element anda longitudinal axis. The first and second magnetic elements may beconfigured to attract the proximal end of the grasper to the controlelement such that the longitudinal axis of the grasper is transverse tothe longitudinal axis of the control element.

In some variations, the distal end of the grasper may comprise anon-magnetic or a diamagnetic material. In some of these variations, thedistal end of the grasper may comprise plastic. In some variations, thedistal end of the grasper may comprise a non-conductive material. Insome instances, the first magnetic element may be a ferromagneticmaterial. In some of these instances, the ferromagnetic material may bea stainless steel. In some variations, the first magnetic element maycomprise a permanent magnet.

In some variations, the grasper may comprise a closed configuration andan open configuration. In the closed configuration, the first jaw andsecond jaw may form a space configured to hold tissue. In othervariations, the grasper may comprise a main body, a first jaw rotatablycoupled to the main body, and a second jaw fixed relative to the mainbody.

In some variations, the second magnetic element may be configured torotate relative to the control element. In other variations, the secondmagnetic element may comprise a diamagnetic material.

In some variations, the systems for grasping tissue described here maycomprise a grasper comprising a longitudinal axis. The grasper mayfurther comprise a first magnetic element positioned along itslongitudinal axis. The systems may further comprise a control elementconfigured to move at least a portion of the grasper. The controlelement may comprise a second magnetic element and a longitudinal axis.The first and second magnetic elements may be configured to attract thegrasper to the control element such that the longitudinal axis of thegrasper and the longitudinal axis of the control element aresubstantially parallel.

In some variations, the first magnetic element may comprise aferromagnetic material. In other variations, the first magnetic elementmay comprise a permanent magnet. In some variations, the grasper mayfurther comprise a third magnetic element. In some variations, the firstmagnetic element may be located at a proximal end of the grasper and thethird magnetic element may be located at a distal end of the grasper.

In some variations, the grasper may further comprise a main body, afirst jaw rotatably coupled to the main body, and a second jaw fixedrelative to the main body. In some of these variations, at least one ofthe first jaw and second jaw may comprise a non-conductive material. Insome instances, the first magnetic element may be positioned at aproximal end of the main body of the grasper. In some variations, thegrasper may comprise a closed configuration and an open configuration.In the closed configuration, the first jaw and second jaw may form aspace configured to hold tissue.

In some variations, the second magnetic element may be configured torotate relative to the control element. In other variations, the secondmagnetic element may comprise a diamagnetic material.

In some variations, the systems for grasping tissue described here maycomprise a grasper comprising a main body, a longitudinal axis, and afirst magnetic element. The first magnetic element may be positioned inthe main body. The systems may further comprise a control elementconfigured to move at least a portion of the grasper. The controlelement may comprise a second magnetic element and a longitudinal axis.The first and second magnetic elements may be configured to attract themain body of the grasper to the control element such that thelongitudinal axis of the grasper and the longitudinal axis of thecontrol element are substantially parallel.

In some variations, the first magnetic element may be the material ofthe main body of the grasper. In other variations, the first magneticelement may comprise a permanent magnet. In still other variations, thegrasper may further comprise a first jaw rotatably coupled to the mainbody and a second jaw fixed relative to the main body.

In some variations, the second magnetic element may be configured torotate relative to the control element. In other variations, the secondmagnetic element may comprise a diamagnetic material.

In yet other variations, the systems for grasping tissue described heremay comprise a grasper comprising a longitudinal axis, a first magneticelement, and a second magnetic element. The systems may further comprisea control element configured to move at least a portion of the grasper.The control element may comprise a third magnetic element, a fourthmagnetic element, and a longitudinal axis. The third and fourth magneticelements may be configured to attract the first and second magneticelements such that the longitudinal axis of the grasper and thelongitudinal axis of the control element are substantially parallel.

In some variations, the first and second magnetic elements may comprisepermanent magnets. In some instances, the third and fourth magneticelements may comprise permanent magnets. In other instances, the thirdmagnetic element may comprise a permanent magnet and the fourth magneticelement may comprise a ferromagnetic or a ferrimagnetic material. Insome variations, the third and fourth magnetic elements may compriseelectro-permanent magnets. In other variations, the third and fourthmagnetic elements may comprise electromagnets.

In some variations, the grasper may further comprise a main body, afirst jaw rotatably coupled to the main body, and a second jaw fixedrelative to the main body. In some of these variations, at least one ofthe first jaw and second jaw may comprise a non-conductive material. Inother variations, the third and fourth magnetic elements may beconfigured to rotate relative to the control element. In yet othervariations, the third and fourth magnetic elements may comprise adiamagnetic material.

In some variations, the methods of performing a surgical proceduredescribed here may comprise grasping tissue in a grasper andmagnetically attracting the grasper to a control element across anabdominal wall. The grasped tissue may be repositioned by manipulating amagnetic element of the control element.

In some variations, the methods of performing a surgical proceduredescribed here may comprise manipulating a first portion of tissuewithin a body cavity of a patient with a first grasper, and manipulatinga second portion of tissue within the body cavity with a second grasper.Manipulating the first portion of tissue with the first grasper maycomprise advancing the first grasper into the body cavity through afirst port using a delivery device, connecting the first grasper to thefirst portion of tissue within the body cavity, disconnecting thedelivery device from the first grasper, and applying a first magneticfield to the first grasper. Manipulating the second portion of tissuewith the second grasper may comprise advancing the second grasper intothe body cavity through the first port or through a second port usingthe delivery device, connecting the second grasper to the second portionof tissue within the body cavity, disconnecting the delivery device fromthe second grasper, and applying a second magnetic field to the secondgrasper.

In some variations, the first magnetic field may be generated by a firstcontrol element. The first control element may be located outside of thebody cavity. In some of these variations, the second magnetic field maybe generated by a second control element. The second control element maybe located outside of the body cavity. In some of these variations, thefirst and second control elements may be connected by a linkage.

In some variations, at least one of the first and second grasper maycomprise a main body, a first jaw, and a second jaw, and may comprise aclosed configuration and an open configuration. In some instances, inthe closed configuration, the first jaw and second jaw may form a spaceconfigured to hold tissue. In some variations, the second grasper may beadvanced into the body cavity through the first port. In somevariations, the second grasper may be advanced into the body cavitythrough the second port. In some variations, the first grasper andsecond grasper may be advanced into the body cavity prior to applyingeither the first magnetic field or second magnetic field.

In some variations, the method may further comprise manipulating a thirdportion of tissue within the body cavity of the patient with the firstgrasper. In some of these variations, manipulating the third portion oftissue with the first grasper may comprise disconnecting the firstgrasper from the first portion of tissue, connecting the first grasperto the third portion of tissue within the body cavity, and applying thefirst magnetic field to the first grasper connected to the third portionof tissue. In some instances, a fourth portion of tissue may bemanipulated within the body cavity of the patient with the secondgrasper. In some of these instances, manipulating the fourth portion oftissue with the second grasper may comprise disconnecting the secondgrasper from the second portion of tissue, connecting the second grasperto the fourth portion of tissue within the body cavity, and applying thesecond magnetic field to the second grasper connected to the fourthportion of tissue.

In other variations, the systems described here may visualize tissue.The systems may comprise a visualization device comprising a proximalend, a distal end, and a longitudinal axis. The visualization device maycomprise a first magnetic element at the proximal end. The systems maycomprise a control element configured to move at least a portion of thevisualization device. The control element may comprise a second magneticelement and a longitudinal axis. The first and second magnetic elementsmay be configured to attract the proximal end of the visualizationdevice to the control element such that the longitudinal axis of thevisualization device is transverse to the longitudinal axis of thecontrol element.

In some variations, the distal end of the visualization device maycomprise a third magnetic element. In other variations, the distal endof the visualization device may comprise a non-magnetic or a diamagneticmaterial. In some instances, the distal end of the visualization devicemay comprise plastic. In some variations, the first magnetic element maybe a ferromagnetic material. In other variations, the distal end of thevisualization device may comprise a non-conductive material. In someinstances, the ferromagnetic material may be stainless steel. In somevariations, the first magnetic element may comprise a permanent magnet.In other variations, the second magnetic element may be configured torotate relative to the control element. In some variations, thevisualization device may be a camera. In some variations, thevisualization device may be a light source. In other variations, thevisualization device may be a camera and a light source.

In yet other variations, the systems described here may visualizetissue. The systems may comprise a visualization device comprising alongitudinal axis. The visualization device may comprise a firstmagnetic element positioned along its longitudinal axis. The systems maycomprise a control element configured to move at least a portion of thevisualization device. The control element may comprise a second magneticelement and a longitudinal axis. The first and second magnetic elementsmay be configured to attract the visualization device to the controlelement such that the longitudinal axis of the visualization device andthe longitudinal axis of the control element are substantially parallel.

In some variations, the first magnetic element may comprise aferromagnetic material. In other variations, the first magnetic elementmay comprise a permanent magnet. In some variations, the visualizationdevice may further comprise a third magnetic element. The first magneticelement may be located in a proximal end of the visualization device andthe third magnetic element may be located in a distal end of thevisualization device. In other variations, a distal end of thevisualization device may comprise a non-conductive material. In yetother variations, the second magnetic element may be configured torotate relative to the control element. In some variations, the secondmagnetic element may comprise a diamagnetic material.

In some variations, the methods of performing a surgical proceduredescribed here may comprise imaging tissue with a camera in a bodycavity and magnetically attracting the camera to a control elementacross an abdominal wall. The camera may be repositioned within the bodycavity by manipulating a magnetic element of the control element.

In some variations, manipulating the magnetic element of the controlelement may comprise rotating the magnetic element relative to thecontrol element. In other variations, the camera may be configured to beasymmetrically attracted to a magnetic field.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1C depict perspective views of an illustrative variation of thesystems described here.

FIGS. 2A-2F depict cross-sectional side views of a distal portion of anillustrative variation of the delivery devices described here and anillustrative variation of the graspers described here.

FIGS. 3A-3B and 4A-4B depict cross-sectional side views of illustrativevariations of the graspers described here.

FIGS. 5A-5E depict illustrative variations of the methods describedhere.

FIGS. 6A and 6B show perspective and side views, respectively, of anillustrative variation of a grasper as described here. FIG. 6C shows across-sectional side view of the grasper of FIGS. 6A and 6B.

FIGS. 7A-7D depict cross-sectional side views of a distal portion of anillustrative variation of the delivery devices described here and thegrasper of FIGS. 6A and 6B.

FIG. 8A depicts a cross-sectional side view of an illustrative variationof a grasper described here. FIG. 8B depicts a cross-sectional side viewof the grasper of FIG. 8A in use with a control element.

FIGS. 9A and 9B depict cross-sectional sides view of illustrativevariations of a grasper described here. FIG. 9C depicts across-sectional side view of the grasper of FIG. 9A in use with acontrol element.

FIG. 10A depicts a cross-sectional side view of an illustrativevariation of a grasper described here. FIGS. 10B and 10C depictcross-sectional side views of the grasper of FIG. 10A in use with acontrol element.

FIG. 11A depicts a cross-sectional side view of another illustrativevariation of a grasper described here. FIGS. 11B and 11C depict across-sectional side view and an inside-the-patient view, respectively,of the grasper of FIG. 11A in use with a control element.

FIG. 12A depicts a cross-sectional side view of another illustrativevariation of a grasper described here. FIGS. 12B and 12C depict across-sectional side view and an inside-the-patient view, respectively,of the grasper of FIG. 12A in use with a control element. FIG. 12Ddepicts a cross-sectional side view of another illustrative depiction ofa camera described here.

FIGS. 13A and 13B-13D depict side and perspective views, respectively,of an illustrative variation of a grasper as described here.

FIGS. 14A-14B and 14C-14D depict side and perspective views,respectively, of an illustrative variation of a grasper as describedhere.

FIGS. 15A-15B and 15C-15D depict side and perspective views,respectively, of an illustrative variation of a grasper as describedhere.

FIG. 16 depicts a perspective view of an illustrative variation of agrasper as described here.

FIG. 17 depicts a side view of an illustrative variation of two graspersin use with two control elements.

FIGS. 18A-18B depict cross-sectional side views of an illustrativevariation of a grasper in use with a control element. FIGS. 18C-18Ddepict cross-sectional side views of an illustrative variation of acamera in use with a control element.

FIGS. 19A-19B depict inside-the-patient views of an illustrativevariation of a grasper in use with a control element.

FIG. 20 depicts a perspective view of an illustrative variation of acontrol element.

FIG. 21 depicts a side view of an illustrative variation of a camera.

DETAILED DESCRIPTION

Described here are devices, systems, and methods for providing remotesuspension/traction and/or manipulation of tissue duringminimally-invasive procedures. Generally, the systems described hereinclude a grasper that may be configured to be releasably connected totissue. The grasper may be further configured to be attracted to one ormore magnetic elements positioned externally of the body to move,reposition, and/or hold the grasper (which may in turn provide tractionfor the tissue held by the grasper). In some variations, the systemsdescribed here may additionally or alternatively comprise avisualization device (e.g., camera, light source) configured to beattracted to one or more magnetic elements positioned externally of thebody to move, reposition, and/or hold the visualization device in adesired location and orientation for visualization during aminimally-invasive procedure.

The systems described here may also comprise a delivery device. Thedelivery devices described here are generally configured to releasablycarry the grasper, and may be further configured to actuate the grasperto selectively connect the grasper to tissue or release the grasper fromtissue. The delivery devices are typically further configured to releasethe grasper from the delivery device (e.g., after the grasper has beenconnected to tissue). In some instances, the delivery device may beconfigured to re-couple to the grasper to reposition or remove thegrasper. In other instances the system may comprise a separate retrievaldevice configured to reposition or remove the grasper. In someinstances, the delivery device or retrieval device may be used with thegrasper to remove tissue from the body. For example, the grasper may beconnected to a tissue such as a gall bladder, the tissue may be severedfrom the body (e.g., using one or more surgical tools), and the graspermay be retrieved using the delivery device or another retrieval deviceto remove the grasper and tissue from the body. It should be appreciatedthat while delivery devices are described herein primarily withreference to use with a grasper, the delivery devices described hereinmay also be used to reversibly couple to another tool to deliver,position and reposition, and/or remove another tool. For example, insome instances the delivery devices may be used to deliver, position andreposition, and/or remove a visualization device, such as a cameraand/or light source.

In some variations, the system may comprise a control element (which mayinclude one or more magnetic elements), which may be configured to bepositioned outside the body and to provide a magnetic force to thegrasper when the grasper is positioned in the body (e.g., to move,reposition, and/or hold the grasper). The control elements describedherein may additionally or alternatively provide a magnetic force to avisualization device (e.g., camera, light source) when a visualizationdevice is positioned within the body (e.g., to move, reposition, and/orhold the visualization device). While illustrative examples of thegraspers and delivery devices are described together below, it should beappreciated that any of the graspers described here may be used with anyof the delivery devices described here, and that any suitablevisualization device (e.g., camera, light source) may be used with anyof the delivery devices described herein. It should be appreciated thatthe graspers described here may be actuated and delivered using anysuitable delivery device, and that that the delivery devices describedhere may be used to actuate and deliver any suitable grasper or graspingdevice. Moreover, while illustrative examples of graspers, visualizationdevices, and control elements are described together below, it should beappreciated that the control elements may be used with any of thegraspers, delivery devices, and suitable visualization devices describedhere.

Generally, the methods described here comprise releasably connecting agrasper (such as one of the graspers described here) to a tissue, andproviding a magnetic force to the grasper to move and/or hold thegrasper and provide traction of the tissue engaged by the grasper. Themagnetic force may be provided by a control element configured toattract and/or repel the grasper.

In some variations, the grasper may be releasably connected to a tissueinside of the body, and the control element may be positioned externallyof the body to affect (e.g., attract, repel, rotate) the grasper. Toconnect the grasper to the tissue, the grasper may be releasably coupledwith a delivery device, wherein the delivery device is configured toactuate the grasper. The delivery device may actuate the grasper toreleasably connect the grasper to tissue, and may eject or otherwisedecouple from the grasper after the grasper is connected to tissue. Whenthe grasper is decoupled from the delivery device, the grasper may beattracted by a magnetic force external to the body and may move orotherwise hold tissue without the need to have a shaft or other portionof a device positioned in a port or other access site. This may reducethe number of access sites required to provide remote suspension oftissue, which may allow for faster and more reliable surgicalprocedures. In some instances, the delivery device (or another device,such as a grasping device) may be used to disconnect the grasper fromtissue. The grasper may then be repositioned and reattached to tissue(either the same tissue or a different tissue), or may be removed fromthe body. Additionally or alternatively, the methods may comprisecontrolling the position and/or orientation a visualization device(e.g., camera, light source) located within the body with a magneticfield generated outside the body by a control element as describedherein.

I. Systems and Devices

FIGS. 1A-1C depict one variation of the systems described here.Specifically, FIG. 1A shows a perspective view of a system comprising adelivery device (100) and a grasper (200). The grasper (200) may bereleasably coupled to the delivery device (100) (as shown in FIGS. 1Aand 1B), and may be decoupled from the delivery device (100) (as shownin FIG. 1C). When the grasper (200) is coupled to the delivery device(100), the delivery device (100) may actuate the grasper to connect thegrasper to tissue and/or release the grasper therefrom.

As shown in FIG. 1A, the delivery device (100) may comprise a handle(104), a shaft (106) extending from the handle (104), and a distalengagement portion (108) at a distal end of the shaft (106). In somevariations, the delivery device (100) and grasper (200) may beconfigured for minimally invasive introduction into a body. Forinstance, in some variations the grasper (200) and delivery device (100)may be configured for advancement through a 10 mm port. In thesevariations, the outer diameter of the grasper (200) may be less than orequal to about 10 mm. Additionally, the delivery device (100) may beconfigured such that the shaft (106) and the distal engagement portion(108) may each have a diameter of less than or equal to about 10 mm.

In some of these variations, the distal engagement portion (108) mayhave an outer diameter of less than or equal to about 10 mm, while theshaft (106) has an outer diameter of less than or equal to about 5 mm.In these variations, it may be possible to advance the distal engagementportion (108) through a 10 mm port, and to further advance a seconddevice having a diameter of about 5 mm or less through the port whilethe shaft (106) is positioned in the port.

It should be appreciated that shaft (106) may have any suitable diameter(e.g., between about 1 mm and about 15 mm, between about 5 mm and about10 mm, or the like). The shaft (106) and distal engagement portion (108)may be formed from any suitable materials, such as one or moremedical-grade, high-strength plastics or metals, such as stainlesssteel, cobalt chromium, PEEK, one or more nylons, polyimide,polycarbonate, ABS, or the like.

It should be appreciated that the systems disclosed herein may comprisea delivery device (100) releasably coupled to a different device than agrasper (200), in order to perform one or more functions within a bodycavity. For instance, the delivery device (100) may be coupled to avisualization device, such as a camera and/or light source, forvisualizing a surgical procedure from a desired position and orientationwithin a body cavity.

A. Tissue Grasping

1. Actuation Control Mechanism

Generally, the handle (104) comprises an actuation control mechanismthat may be manipulated by a user to controllably actuate the grasper(200). In some variations, the delivery device (100) may comprise aseparate decoupling control, which a user may use to decouple thegrasper (200) from the delivery device (100). In other variations, thedelivery device (100) may be configured such that a user may use theactuation control mechanism to decouple the grasper (200) from thedelivery device (100) in addition to actuating the grasper (200). Forexample, in the variation of the delivery device (100) depicted in FIGS.1A-1C, the handle (104) of delivery device (100) may comprise a gripportion (110) and an actuation control mechanism comprising a trigger(112). While shown in FIGS. 1A-1C as being a trigger (112), it should beappreciated that the actuation control mechanism may comprise anysuitable control element (e.g., a slider, a knob, or the like) capableof actuating the grasper (200) as described in more detail below. Thetrigger (112) may be configured to both actuate the grasper (200) anddecouple the grasper (200) from the delivery device (100).

Specifically, in some variations the trigger (112) may be moveablebetween three positions. While three distinct positions will bediscussed below, it should be appreciated that the trigger (112) mayalso assume one or more intermediate positions between these positions.Of the three positions, the trigger (112) may be moveable between afirst position (as shown in FIG. 1A) and a second position (as shown inFIG. 1B) to actuate the grasper (200). Specifically, the grasper (200)may comprise a first jaw (202) and a second jaw (204), and at least oneof the first jaw (202) and the second jaw (204) may be configured torotate relative to the grasper (200). The grasper (200) may be actuatedbetween an open configuration and a closed configuration.

In the open configuration, the first jaw (202) and second jaw (204) maybe held in rotationally separated positions to define a space betweenthe first jaw (202) and the second jaw (204), as shown in FIG. 1B. Inthe closed configuration, the first jaw (202) and second jaw (204) maybe rotationally biased toward each other, as shown in FIG. 1A. While thefirst jaw (202) is shown in FIG. 1A as contacting the second jaw (204)when the grasper (200) is in the closed configuration, it should beappreciated that when the grasper (200) is connected to tissue, tissuepositioned between the first jaw (202) and second jaw (204) may preventthe first jaw (202) from contacting the second jaw (204) when thegrasper (200) is in the closed configuration.

The grasper (200) may be actuated between the closed and openconfigurations to releasably connect the grasper (200) to tissue. Forexample, when the trigger (112) is in the first position (as shown inFIG. 1A), the grasper (200) may be placed in the closed configuration.As the trigger (112) is moved to the second position (as shown in FIG.1B), the grasper (200) may be moved to the open configuration. Invariations where the first jaw (202) is configured to rotate relative tothe grasper (200), moving the trigger (112) from the first position tothe second position may rotate the first jaw (202) away from the secondjaw (204), while moving the trigger (112) from the second position backto the first position may rotate the first jaw (202) toward the secondjaw (204). Accordingly, by moving the trigger (112) between the firstand second positions, a user may selectively open and close the jaws(202, 204) of the grasper (200) using the delivery device (100). Toconnect the grasper (200) to tissue, a user may place the trigger (112)in the second position (or an intermediate position between the firstand second positions) to open (or partially open) the jaws (202, 204),and may manipulate the delivery device (100) to position tissue betweenthe first jaw (202) and the second jaw (204). With the tissue positionedbetween the jaws (202, 204), the trigger (112) may be returned to thefirst position to close the jaws (202, 204) to clamp the jaws (202, 204)against the tissue, thereby releasably connecting the grasper (200) tothe tissue.

As mentioned above, the trigger (112) in some variations may beconfigured to decouple the grasper (200) from the delivery device (100).For example, the trigger (112) may be moved from the first position (asshown in FIG. 1A) to a third position (as shown in FIG. 1C), and thedelivery device (100) may be configured to decouple from the grasper(200) when the trigger (112) is moved to the third position (as will bedescribed in more detail below). When the same actuation controlmechanism is used to actuate the grasper (200) and decouple the grasper(200) from the delivery device (100), it may be desirable to decouplethe grasper (200) from the delivery device (100) when the grasper (200)is in a closed configuration and engaged with tissue. Accordingly, insome variations, the first position of the trigger (112) (which maycorrespond to a closed configuration of the grasper (200)) may be anintermediate position between the second position and third position. Inthese variations, when the trigger (112) is placed in the secondposition to place the grasper (200) in an open configuration, thetrigger (112) will move through the first position (which may move thegrasper (200) to a closed configuration) before it reaches the thirdposition. Thus the grasper (200) may be moved to the closedconfiguration before it is decoupled from the delivery device (100).

The delivery devices described here may be configured to actuate, coupleto, and decouple from, the graspers described here in any suitablemanner. Furthermore, the delivery devices described here may beconfigured to couple to and decouple from a suitable visualizationdevice (e.g., camera, light source). When decoupling and coupling aredescribed herein with respect to the delivery devices and grasper, itshould be appreciated that the same mechanisms and methods may be usedfor decoupling and coupling the delivery devices and suitablevisualization devices. For example, FIGS. 2A-2F illustrate one suitablemechanism by which a delivery device may be configured to actuate andcouple/decouple a grasper. For example, FIG. 2A depicts across-sectional side view of variations of the grasper (200) and adistal portion of the delivery device (100) each described above withrespect to FIGS. 1A-1C. As shown there, the grasper (200) may comprise afirst jaw (202), a second jaw (204), and a main body (206). Generally,the first jaw (202) is rotatably connected to the main body (206) at apivot point (208), such that the first jaw (202) may rotate relative tothe main body (206). In some variations (such as that shown in FIGS.2A-2F), the second jaw (204) may be fixed relative to the main body(206), while in other variations the second jaw (204) may also berotatably connected to the main body (206). When the second jaw (204) isfixed relative to the main body (206), the second jaw (204) may beformed separately from the main body (206) and subsequently attachedthereto, or may be formed integrally with the main body (206). When ajaw as described here is configured to rotate relative to a pivot point,the jaw may be configured to rotate in any suitable manner. In somevariations, a jaw (202) may be connected to the main body (206) via arotation pin (208), such that the jaw (202) may rotate around therotation pin (208) (or the jaw (202) and rotation pin (208) may rotaterelative to the main body (206)). In other variations, the jaw may beconnected to the main body via a living hinge.

The first jaw (202) and second jaw (204) may be rotationally biasedtoward each other (e.g., towards a closed configuration). In variationswhere the first jaw (202) is rotatably connected to the main body (206),the first jaw (202) may be rotationally biased toward the second jaw(204). For example, in some variations the grasper (200) may comprise aspring such as a torsional spring or a cantilever spring (not shown),which may spring-bias the first jaw (202) toward the second jaw (204).In variations where the second jaw (204) is rotatably connected to themain body (206), the second jaw (204) may also be biased towards thefirst jaw (202) (e.g., via one or more springs). The bias of the jaws(202, 204) toward the closed configuration may act to hold tissuepositioned between the first jaw (202) and the second jaw (204).

As shown in FIG. 2A, the main body (206) of the grasper (200) maycomprise a barrel portion (210) with a lumen (212) extendingtherethough. A portion of the delivery device (100) may be advancedthrough the lumen (212) to rotate first jaw (202) (and in someinstances, the second jaw (204) in variations where the second jaw (204)is rotatably connected to the main body (206)) relative to the main body(206), as will be described in more detail below. In some variations,the lumen (212) may have a constant diameter. In other variations,different portions of the lumen (212) may have different diameters.

For example, in the variation of the grasper (200) shown in FIGS. 2A-2F,the lumen (212) of the barrel portion (210) may comprise a proximalsegment (214), a distal segment (216), and an intermediate segment (218)positioned between the proximal segment (214) and the distal segment(216). As shown in FIG. 2A, the proximal segment (214) may have a largerdiameter than the distal segment (216), and the intermediate segment(218) may have a larger diameter than both the proximal segment (214)and the distal segment (216). The proximal (214), distal (216), andintermediate (218) segments may aid in maintaining a coupling with thedelivery device (100), as will be described in more detail below.

The barrel portion (210) of the grasper (200) may be sized andconfigured to be engaged by the distal engagement portion (108) of thedelivery device (100) to releasably couple the grasper (200) to thedelivery device (100). In some variations, the outer diameter of thebarrel portion (210) may have a constant diameter, or may have differentportions of the barrel portion (210) having different diameters, such asdescribed in more detail below. Turning to the delivery device (100), inthe variation of the delivery device shown in FIGS. 2A-2F, the deliverydevice (100) may comprise an actuation rod (114) slidably disposed inthe shaft (106). The actuation rod (114) may be advanced through thelumen (212) of the barrel portion (210) of the grasper (200) to actuatethe grasper (200), as will be described in more detail below. Also shownin FIG. 2A is a locking sheath (116), a coupling magnet (118), and aspring (120). Each of these components will be discussed further below.

While shown in FIGS. 2A-2F as having a coupling magnet (118), thedelivery device (100) need not comprise a coupling magnet. In variationsof the delivery device (100) that do comprise a coupling magnet (118),the coupling magnet (118) may be slidably housed in a housing of thedistal engagement portion (108), and may be configured to releasablycouple the delivery device (100) to the grasper (200). The couplingmagnet (118) may be movable between an advanced position (as depicted inFIG. 2A) and a retracted position (as depicted in FIG. 2C). Invariations where the delivery device (100) comprises a spring (120), thespring (120) may be positioned in the distal engagement portion (108) tobias the coupling magnet (118) toward the advanced position.

The delivery device (100) may be configured to couple to the grasper(200) when the coupling magnet (118) is in the advanced position. Forexample, when the distal engagement portion (108) is brought near thegrasper (200), the coupling magnet (118) may attract the grasper (200).Generally, at least a portion of the graspers described here are formedfrom one or more materials that may be attracted to a magnetic field.The materials may include one or more permanent magnets, or one or moreferromagnetic or ferrimagnetic materials, such as, for example,stainless steel, iron, cobalt, nickel, neodymium iron boron, samariumcobalt, alnico, ceramic ferrite, alloys thereof and/or combinationsthereof. The particular configuration of the materials within thegrasper—for example, the type, amount, polarity, and location of thematerials—may alter how the grasper responds to and/or interacts with acontrol element, and is discussed in more detail below.

Accordingly, one or more portions of the grasper (200) may be formedfrom or otherwise include a material that may be attracted to a magneticfield produced by the coupling magnet (118). The attractive forceprovided by the coupling magnet (118) may hold the grasper (200) againstor at least partially within the distal engagement portion (108), suchas shown in FIG. 2B. The grasper (200) may be positioned such that aproximal end of the barrel portion (210) of the grasper (200) is heldagainst or at least partially within the distal engagement portion (108)of the delivery device (100).

To decouple the grasper (200) from the distal engagement portion (108),the coupling magnet (118) may be withdrawn to the retracted position, asshown in FIG. 2C. Because the attractive force applied by a magnetdecreases as a function of the distance from the magnet, moving thecoupling magnet (118) to the retracted position (e.g., by an actuationcontrol mechanism) may increase the distance between the grasper (200)and the coupling magnet (118) (e.g., the distal engagement portion (108)may comprise a stop (121) which may prevent the grasper (200) from beingretracted with the coupling magnet (118)), which may reduce theattractive force applied to the grasper (200). Eventually, theattractive force may be sufficiently diminished such that the grasper(200) may decouple from the delivery device (100).

Nevertheless, the coupling magnet (118) may be retracted in any suitablemanner. In some variations, the delivery device (100) may comprise acontrol sheath (not shown) which may be attached to the coupling magnet(118). The control sheath may be selectively withdrawn or advanced fromthe grasper (200) (e.g., via a control mechanism in the handle (104)) towithdraw and advance, respectively, the coupling magnet (118). In othervariations, a portion of the actuation rod (114) may be configured toretract the coupling magnet (118). For example, the actuation rod (114)may be configured to catch on or otherwise engage the coupling magnet(118) during retraction of the actuation rod (114). In these variations,the actuation rod (114) may be withdrawn until the actuation rod (114)engages the coupling magnet (118). Once the actuation rod (114) engagesthe coupling magnet (118), further withdrawal of the actuation rod (114)may also withdraw the coupling magnet (118).

For example, as shown in FIGS. 2A-2F, the actuation rod (114) may beslidably disposed within a lumen (122) of the coupling magnet (118). Insome variations, at least a segment of the actuation rod (114) may besized and configured such that the portion of the actuation rod (114)cannot fully pass through the lumen (122). For example, in somevariations a segment of the actuation rod (114) may have a diametergreater than a diameter of the lumen (122). Additionally oralternatively, the segment may comprise one or more projectionsextending from an outer surface of the actuation rod (114) and whichcannot fully pass through the lumen (122). When the segment of theactuation rod (114) is positioned distal to the coupling magnet (118),the actuation rod (114) may be freely advanced relative to the couplingmagnet (118). Conversely, withdrawal of the actuation rod (114) may pullthe segment of the actuation rod (114) into contact with the couplingmagnet (118). Since the segment cannot fully pass through the lumen(122) of the coupling magnet (118), further withdrawal of the actuationrod (114) may cause the segment of the actuation rod (114) to pull onand withdraw the coupling magnet (118). When the actuation rod (114) issubsequently advanced, the spring (120) may advance the coupling magnet(118) with the actuation rod (114) until the coupling magnet (118)reaches the advanced position.

In variations where the delivery device (100) comprises a locking sheath(116) slidably disposed in the lumen (122) of the coupling magnet (118),the locking sheath (116) may be configured to withdraw the couplingmagnet (118). For example, a segment of the locking sheath (116) may besized and configured such that the segment cannot fully pass through thelumen (122) of the coupling magnet (118), such as described above withrespect to the actuation rod (114). In the variation shown in FIGS.2A-2F, the locking sheath (116) may comprise a protrusion (124)positioned distally of the coupling magnet (118) and sized such that theprotrusion (124) cannot fully pass through the lumen (122). In thesevariations, proximal withdrawal of the locking sheath (116) through thelumen (122) may place the protrusion (124) into contact with thecoupling magnet (118), such as shown in FIGS. 2A and 28 . As depicted inFIG. 2C, further withdrawal of the locking sheath (116) may alsowithdraw the coupling magnet (118) (e.g., by virtue of the contactbetween the protrusion (124) and the coupling magnet (118)).

As mentioned above, the delivery devices described here may comprise alocking sheath (although it should be appreciated that in somevariations the delivery device may not comprise a locking sheath). Invariations where the delivery device does comprise a locking sheath(116), such as the variation of the delivery device (100) depicted inFIGS. 2A-2F, the locking sheath (116) may be slidably disposed in theshaft (106). The actuation rod (114) may in turn be positioned at leastpartially within the locking sheath (116). The locking sheath (116) maycomprise an expandable distal portion (126) which may be configured toexpand inside of the lumen (212) of the barrel portion (210) of thegrasper (200) to temporarily engage an interior portion of the lumen(212), which may help maintain the coupling between the grasper (200)and the delivery device (100).

In these variations, the delivery device (100) may be configured suchthat advancement of the actuation rod (114) relative to the lockingsheath (116) may expand the expandable distal portion (126) of thelocking sheath (116). For example, the expandable distal portion (126)of the locking sheath (116) may comprise at least one internalprojection (128) that projects inwardly and is sized and shaped to fitwithin at least one corresponding indentation (130) in the outer surfaceof the actuation rod (114). It should be appreciated that at least oneinternal projection (128) may be a single projection (e.g., an annularsnap-fit or a projection that extends radially around some or all of theinner circumference of the locking sheath (116)) or multiple discreteprojections. Similarly, the actuation rod (114) may comprise a singleindentation (e.g., an indentation that extends radially around some orall of the outer surface of actuation rod (114)) or multipleindentations.

The actuation rod (114) may be positioned within the locking sheath(116) such that the internal projections (128) of the locking sheath(116) are positioned in corresponding indentations (130) of theactuation rod (114), such as shown in FIGS. 2A-2D. This may create afriction fit or mechanical interlock between the actuation rod (114) andthe locking sheath (116), which may cause the locking sheath (116) to beadvanced and withdrawn with the actuation rod (114).

The engagement between the actuation rod (114) and the locking sheath(116) may be further configured such that under certain circumstancesthe actuation rod (114) may be advanced relative to the locking sheath(116) to expand the expandable distal portion (126) of the lockingsheath (116). For example, as shown in FIGS. 2A-2F, the internalprojections (128) of the locking sheath (116) and the correspondingindentations (130) of the actuation rod (114) may each have a rampedproximal portion. When the internal projections (128) are positionedwithin corresponding indentations (130), the ramped proximal portion ofeach internal projection (128) may be positioned in contact with theramped proximal portion of a corresponding indentation (130). Thiscontact may provide the friction fit or mechanical interlock that mayallow the actuation rod (114) to distally advance the locking sheath(116) as mentioned above.

When an external force is applied to the locking sheath (116) to resistdistal advancement of the locking sheath (116), advancement of theactuation rod (114) may overcome the friction force or mechanicalconnection between the ramped proximal portions of the internalprojections (128) and the corresponding indentations (130), at whichpoint the contacting ramped surfaces may slide relative to each other asthe actuation rod (114) begins to advance distally relative to thelocking sheath (116). As the actuation rod (114) is advanced distallyrelative to the locking sheath (116), the internal projections (128) mayslide out of their corresponding indentations (130) (such as shown inFIG. 2E), which may thereby expand the expandable distal portion 126) ofthe locking sheath (116).

This expansion of the expandable distal portion (126) of the lockingsheath (116) may help to maintain the temporary coupling between thedelivery device (100) and the grasper (202), as illustrated in FIGS.2D-2F. Specifically, the locking sheath (116) and actuation rod (114)may be positioned such that the internal projections (128) of thelocking sheath (116) are positioned in respective indentations (130) onthe actuation rod (114), which may allow advancement and retraction ofthe actuation rod (114) to advance and retract the locking sheath (116),as discussed above. The grasper (200) may be coupled to the distalengagement portion (108) of the delivery device (100), as shown in FIG.2C, and the actuation rod (114) may be advanced to begin advancing theactuation rod (114) and locking sheath (116) into the lumen (212) of thebarrel portion (210) of the grasper (200). The actuation rod (114) maybe sized such that it is smaller than each of the proximal segment(214), the distal segment (216), and the intermediate segment (218) ofthe lumen (212) of the barrel portion (210) of the grasper (200). Thismay allow the actuation rod (114) to be advanced through the entirelumen (212) of the barrel portion (210). The locking sheath (116),however, may be sized and configured such that it may pass through theproximal segment (214) and the intermediate segment (218) of the lumen(212), but is prevented from entering the distal segment (216).Accordingly, the actuation rod (114) may be advanced to advance theactuation rod (114) and the locking sheath (116) through the lumen (212)of the barrel portion (210) of the grasper (200) until the lockingsheath (116) reaches the distal segment (216) of the lumen (212), asshown in FIG. 2D. At this point, the locking sheath (116) may beprevented from entering the distal segment (216), and may thus beprevented from further advancement.

The actuation rod (114) may be further advanced relative to the grasper(200) to advance the actuation rod (114) through the distal segment(216) of the lumen (212). Because the locking sheath (116) is preventedfrom advancing further, the actuation rod (114) may be advanced relativeto the locking sheath (116). This may cause the internal projections(128) of the locking sheath (116) to slide out of their respectiveindentations (130) and expand the expandable distal portion (126) of thelocking sheath (116), as depicted in FIG. 2E. Specifically, theexpandable distal portion (126) may be positioned in the intermediatesegment (118) of the lumen (112) when it is expanded.

When expanded, the expandable distal portion (126) may be configured toresist being removed from the lumen (212) of the barrel portion (210) ofthe grasper (200). Specifically, the expandable distal portion (126) ofthe locking sheath (116) may be sized and configured such that, whenexpanded, the expandable distal portion (126) may be prevented frompassing through the proximal segment (214) of the lumen (212) (e.g., theouter diameter of the expanded distal portion (126) may be larger thanthe diameter of the proximal segment (214) of the lumen (212)). When theexpandable distal portion (126) of the locking sheath (116) is expandedin the intermediate segment (218) (as shown in FIG. 2E), the lockingsheath (116) may resist both advancement of the locking sheath (116)into the distal segment (216) (as discussed above) and withdrawal of thelocking sheath (116) though the proximal segment (214) of the lumen(212). Accordingly, the expanded locking sheath (116) may lock thegrasper (200) in place relative to the delivery device (100).

When the actuation rod (114) is further advanced to actuate the jaws(202, 204) of the grasper (200) (as shown in FIG. 2F, and discussed inmore detail below), the actuation rod (114) may apply one or more forcesto the grasper (200) which may have a tendency to push the grasper (200)away from the coupling magnet (118) (which in some instances couldpossibly inadvertently decouple the grasper (200) from the deliverydevice (100)), but the engagement between the expanded locking sheath(116) and the grasper (200) may overcome these forces to maintain theposition of the grasper (200) relative to the delivery device (100).

To disengage the locking sheath (116) from the grasper (200), theactuation rod (114) may be retracted until the indentations (130) of theactuation rod (114) reach the internal projections (128) of the lockingsheath (116). The expandable distal portion (126) of the locking sheath(116) may be biased toward an unexpanded state such that the internalprojections (128) reposition themselves into their respectiveindentations (130), as shown in FIG. 2D. The actuation rod (114) maythen be withdrawn to withdraw the locking sheath (116) (e.g., by virtueof the connection between the indentations (130) and the internalprojections (128)).

The grasper (200) may be configured to be actuated in any suitablemanner. In some variations, the grasper (200) may be configured suchthat it may be actuated by a force applied internally of the grasper(200) (e.g., via an actuation rod (114) of the delivery device (100)advanced through the lumen (212) of the barrel portion (210) of thegrasper (200), as discussed in more detail below), and may be furtherconfigured such that it may be actuated by a force applied externally ofa grasper (200) (e.g., via a grasping device). For example, in thevariation of the grasper (200) shown in FIGS. 2A-2F, the grasper (200)may comprise a proximal arm (220) connected to the first jaw (202),wherein rotation of the proximal arm (220) rotates the first jaw (202)relative to the main body (206) and second jaw (204) of the grasper(200). The proximal arm (220) may act as a lever and/or a cam to rotatethe first jaw (202).

For example, in some instances the proximal arm (220) may act as a camto rotate the first jaw (202). In these instances, the actuation rod(114) of the delivery device (100) may rotate the first jaw (202).Specifically, a portion of the proximal arm (220) may be alignedrelative to the lumen (212) such that advancement of the actuation rod(114) through the lumen (212) pushes the actuation rod (114) intocontact with the proximal arm (220), as illustrated in FIG. 2E. Once incontact with the proximal arm (220), advancement of the actuation rod(114) may push against the proximal arm (220). The proximal arm (220)may act as a cam to convert the linear motion of the actuation rod (114)into rotation of the proximal arm (220), which may in turn rotate thefirst jaw (202) away from the second jaw (204) as shown in FIG. 2F. Whenthe first jaw (202) is spring-biased toward the second jaw (204), therotation of the proximal arm (220) may overcome this spring bias, whichmay allow the actuation rod (114) to hold the first jaw (202) in itsopen position. Additionally, the first jaw (202) may rotate back towardthe second jaw (204) when the actuation rod (114) is retracted.

Additionally, in the variation of the grasper (200) shown in FIGS.2A-2F, at least a portion of the proximal arm (220) may be exposedrelative to the main body (206), which may allow a grasping device tograsp the proximal arm (220) to rotate the first jaw (202) relative tothe second jaw (204). For example, opposing forces (represented byarrows (222) in FIG. 2A) may be applied (e.g., via a grasping device) tothe exposed portion of the proximal arm (220) and the main body (206) tocause the proximal arm (220) to rotate around the pivot point (208)(which may in turn rotate the first jaw (202) away from the second jaw(204)).

While the proximal arm (220) is shown in FIGS. 2A-2F as being curved, itshould be appreciated that in some variations the graspers describedhere may also comprise one or more straight segments. For example, FIGS.3A and 3B depict cross-sectional side views of one such variation of agrasper (300) which may be used with the systems described here. Asshown there, the grasper (300) may comprise a first jaw (302), a secondjaw (304), and a main body (306). The first jaw (302) may be rotatablycoupled to the main body (306) at a pivot point (308), and the main body(306) of the grasper (300) may comprise a barrel portion (310) having alumen (312) extending therethrough. In some variations, the lumen (312)may comprise a proximal segment (314), a distal segment (316), and anintermediate segment (318), which may be configured as described abovewith respect to the variation of the grasper (200) depicted in FIGS.2A-2F.

As shown in FIGS. 3A and 3B, the grasper (300) may comprise a proximalarm (320) connected to or otherwise extending from the first jaw (302)such that rotation of the proximal arm (320) around the pivot point(308) also rotates the first jaw (302) around the pivot point. In thisvariation, the proximal arm (320) may comprise a straight segment (322)and a curved segment (324), and the proximal arm (320) may act as a camand/or lever to rotate the first jaw (302). Specifically, the straightsegment (322) may be positioned between the curved segment (324) and thefirst jaw (302), and may provide a flat surface which may facilitateengagement of the proximal arm (320) by a grasping device. For example,as shown in FIGS. 3A and 3B, at least a portion of the straight segment(322) may be exposed from the main body (306). Some or all of the curvedsegment (324) may also be exposed, although in some variations, thecurved segment (324) may be at least partially positioned within achannel (326) in the barrel portion (310) of the grasper (300).

Opposing forces (represented in FIG. 3A by arrows (328)) may be applied(e.g., via a grasping device) to an exposed portion of the straightsegment (322) (and/or an exposed portion of the curved segment (324),when at least a portion of the curved segment (324) is exposed) and themain body (306), which may cause the proximal arm (320) to act as alever to rotate around the pivot point (308). This in turn may rotatethe first jaw (302) away from the second jaw (304), as illustrated inFIG. 3B. When the first jaw (302) is configured to be rotatably biasedtoward the second jaw (304) (e.g., via one or more springs, as describedin more detail above), and the forces (328) holding the first jaw (302)rotated away from the second jaw (304) are removed from the proximal arm(320) and the main body (306), the first jaw (302) may rotate backtoward the second jaw (304), as illustrated in FIG. 3A. When tissue ispositioned between the first jaw (302) and the second jaw (304), thismay connect the grasper (300) to the tissue as discussed in more detailabove.

Additionally, a delivery device (such as the delivery device (100)described above with respect to FIGS. 1A-1C and 2A-2F) may be configuredto actuate the jaws of the grasper (300) through the barrel portion(310), as illustrated in FIGS. 3A and 38 . The distal engagement portion(108) of the delivery device (100) may engage the barrel portion (310)of the grasper (300) (as discussed in more detail above), and theactuation rod (114) may be advanced through the lumen (312) of thebarrel portion (310) until the actuation rod (114) contacts the curvedsegment (324) of the proximal arm (320), such as shown in FIG. 3A. Insome instances, advancing the actuation rod (114) to this point maycause a locking sheath (116) of the delivery device (100) to couple tothe lumen (312) of the barrel portion (310) of the grasper (300), suchas described in more detail above.

Further advancement of the actuation rod (114) may push the actuationrod (114) against the curved segment (324) of the proximal arm (320),and the proximal arm (320) may act as a cam to convert the linearmovement of the actuation rod (114) into rotational movement of theproximal arm (320). As the actuation rod (114) rotates the proximal arm(320), the first jaw (302) may rotate away from the second jaw (304), asdepicted in FIG. 3B. When the actuation rod (114) is withdrawn, thefirst jaw (302) may be biased to rotate toward the second jaw (304) toreturn the first jaw (302) toward the second jaw (304). Accordingly, theactuation rod (114) may be advanced and withdrawn to cause the first jaw(302) to rotate away from and toward, respectively, the second jaw(304).

Additionally, positioning the straight segment (322) between the curvedsegment (324) and the pivot point (308) may create a longer moment arm,which may reduce the force that must be applied to the curved segment(324) by the actuation rod (104) in order to rotate the first jaw (302).While the proximal arm (320) shown in FIGS. 3A and 3B is configured suchthat a concave portion of the curved segment (324) faces the lumen (312)such that the actuation rod (114) contacts the concave portion of thecurved segment (324) during advancement of the actuation rod (114), thecurved segment may instead be configured such that a convex portion of acurved segment faces the lumen such that the actuation rod (114)contacts the convex portion of the curved segment during advancement ofthe actuation rod (114).

While the variations of the graspers depicted in FIGS. 2A-2F and 3A-3Beach comprise a proximal arm that is configured to be used as both a camand a lever to actuate the grasper, in some variations the grasper maycomprise a first mechanism which may act as a cam to actuate the grasperand a second mechanism which may act as a lever to actuate the grasper.For example, FIGS. 4A and 4B depict one such variation of a grasper(400) suitable for use with the systems described here. As shown there,the grasper (400) may comprise a first jaw (402), a second jaw (404),and a main body (406). The first jaw (402) may be rotatably coupled tothe main body (406) at a pivot point (408), and the main body (406) ofthe grasper (400) may comprise a barrel portion (410) having a lumen(412) extending therethrough, in some variations, the lumen (412) maycomprise a proximal segment (414), a distal segment (416), and anintermediate portion (418), which may be configured as described abovewith respect to the variation of the grasper (200) depicted in FIGS.2A-2F.

Also shown in FIGS. 4A and 4B are a proximal arm (420) and an eccentriccam member (422). Each of the proximal arm (420) and the eccentric cammember (422) may be attached to the first jaw (402), such that rotationof either the proximal arm (420) or the eccentric cam member (422)relative to the pivot point (408) may rotate the first jaw (402). Forexample, opposing forces (represented by arrows (428)) may be applied tothe main body (406) and the proximal arm (420), which may rotate theproximal arm (420) relative to the main body (406) and act as a lever torotate the first jaw (402) away from the second jaw (404), such as shownin FIG. 4B. In some variations, the first jaw (402) may be rotatablybiased toward the second jaw (404) (e.g., via one or more springs, asdescribed in more detail above), such that when the forces (428) areremoved from the proximal arm (420) and/or main body (406), the firstjaw (402) may rotate back toward the second jaw (404), as illustrated inFIG. 4A.

Similarly, the eccentric cam member (422) may be rotated via a portionof a delivery device that may be advanced through the lumen (412) of thebarrel portion (410) of the grasper (400). In some instances, thedelivery device (100) described above may actuate the grasper (400). Thedistal engagement portion (108) of the delivery device (100) may engagethe barrel portion (410) of the grasper (400) (as discussed in moredetail above), and the actuation rod (114) may be advanced through thelumen (412) of the barrel portion (410) until the actuation rod (114)contacts the eccentric cam member (422) (which may be aligned with thelumen (412)), such as shown in FIG. 4A. In some instances, advancing theactuation rod (114) to this point may cause a locking sheath (116) ofthe delivery device (100) to couple to the lumen (412) of the barrelportion (410) of the grasper (40), such as described in more detailabove.

Further advancement of the actuation rod (114) may push against theeccentric cam member (422), which may convert the linear movement of theactuation rod (114) into rotational movement of the eccentric cam member(422). As the actuation rod (114) rotates the eccentric cam member(422), the first jaw (402) may rotate away from the second jaw (404), asdepicted in FIG. 4B. When the actuation rod (114) is withdrawn, thefirst jaw (402) may be biased to rotate back toward the second jaw(404). Accordingly, the actuation rod (114) may be advanced andwithdrawn to cause the first jaw (402) to rotate away from and toward,respectively, the second jaw (404).

Returning to FIGS. 2E-2F, the actuation rod (114) may be advanced andwithdrawn in any suitable manner. For example, when the delivery device(100) comprises an actuation control mechanism, such as a slider, knob,trigger, or the like, the actuation control mechanism may be operativelyconnected to the actuation rod (114) such that the actuation controlmechanism may advance and withdraw the actuation rod (114). For example,in the variation of the delivery device (100) shown in FIGS. 1A-1C, thetrigger (112) may be configured to advance and retract the actuation rod(114). In some of these variations, the trigger (112) may be configuredsuch that rotation of the trigger (112) toward the grip portion (110)withdraws the actuation rod (114) relative to the shaft (106), whilerotation of the trigger (112) away from the grip portion (110) advancesthe actuation rod (105) relative to the shaft.

In these variations, when the trigger (110) is in the first position (asshown in FIG. 1A), the actuation rod (114) may be positioned as shown inFIGS. 2A and 2B with the coupling magnet (118) in an advanced position,which may allow the distal engagement portion (108) to connect to agrasper (such as grasper (200), as illustrated in FIGS. 1A and 2B). Thetrigger (112) may be rotated toward the grip portion (110) to positionthe trigger (112) in the third position (as shown in FIG. 1C), and thisrotation may retract the actuation rod (114) relative to the shaft(106). Retraction of the actuation rod (114) may also withdraw thecoupling magnet (118) to a retracted position, such as illustrated inFIG. 2C, which may decouple a grasper from the delivery device (100) asdescribed above. The trigger (112) may be rotated away from the gripportion (110) and back to the first position to advance the actuationrod (114) back to the position shown in FIGS. 2A and 2B.

Further rotation of the trigger (112) away from the grip portion (110)may move the trigger (112) from the first position to the secondposition (as shown in FIG. 1B) and may advance the actuation rod (114)through a lumen of a barrel portion of a grasper (e.g., the lumen (212)of the barrel portion (210) of the grasper (200) described above) torotate one or more jaws of the grasper (as shown in FIG. 2F). Returningthe trigger (112) to the first position (e.g., by rotating the trigger(112) toward the grip portion (110)) may withdraw the actuation rod(114) relative to the shaft (106) and the grasper, which may allow thegrasper to return to a closed configuration. It should be appreciatedthat in some variations, rotation of the trigger (112) toward the gripportion (110) may be configured to advance the actuation rod (114)relative to the shaft (106), while rotation of the trigger 112) awayfrom the grip portion (110) may retract the actuation rod (114) relativeto the shaft (106).

FIGS. 6A-6C depict another variation of a grasper (600) as describedhere. Specifically, FIGS. 6A and 6B show perspective and side views,respectively, of the grasper (600). As shown there, the grasper (600)may comprise a first jaw (602), a second jaw (604), and a main body(606). Generally, the first jaw (602) may be rotatably connected to themain body (606) at a pivot point (608), such that the first jaw (602)may rotate relative to the main body (606). While the second jaw (604)is shown in FIGS. 6A-6C as being fixed relative to the main body (606),it should be appreciated that in some variations the second jaw (604)may be rotatably connected to the main body (606), such as discussed inmore detail above. The first jaw (602) (and/or the second jaw (604) invariations where the second jaw (604) is rotatably connected to the mainbody (606)) may be rotated relative to the main body (606) to actuatethe grasper (600) between an open configuration and a closedconfiguration.

Specifically, in the open configuration, the first jaw (602) and thesecond jaw (604) may be held in rotationally separated positions todefine a space between the first jaw (602) and the second jaw (604), asshown in FIG. 6A. In the closed configuration, the first jaw (602) andsecond jaw (604) may be rotationally biased toward each other, as shownin FIG. 6B. While the first jaw (602) is shown as contacting the secondjaw (604) in FIG. 6B, it should be appreciated that when the grasper(600) is connected to tissue, tissue positioned between the first jaw(602) and the second jaw (604) may prevent the first jaw (602) fromcontacting the second jaw (604) when the grasper is in the closedconfiguration. The first jaw (602) and second jaw (604) may berotationally biased toward a closed configuration in any suitable manner(e.g., via a torsional spring (not shown)), such as described in moredetail above.

The main body (606) of the grasper (600) may comprise a barrel portion(610) with a lumen (612) extending therethrough. A portion of a deliverydevice may be advanced at least partially into the lumen (612) toactuate the grasper (600) between closed and an open configurations, aswill be discussed in more detail below. The outer diameter of the barrelportion (610) may be uniform, or may vary along the length of the barrelportion (610). For example, in the variation of the grasper (600) shownin FIGS. 6A-6C, the barrel portion (610) may have a first segment (640)having a first outer diameter and a second segment (642) having a secondouter diameter. In some variations, the first outer diameter may begreater than the second outer diameter, which may allow the firstsegment (640) to act as a stop when engaged by a delivery device, suchas discussed in more detail herein. For example, in some variations thefirst segment may have a first outer diameter of about 10 mm, and thesecond segment may have an outer diameter between about 7 mm and about 9mm.

In some variations (such as the variation of grasper (600) illustratedin FIGS. 6A-6C), the barrel portion (610) may further comprise a taperedportion (644) positioned between the first segment (640) and the secondsegment (642), such that the outer diameter of the tapered segment (644)tapers between the first outer diameter and the second outer diameter.It should be appreciated, however, that the barrel portion (610) neednot have such a tapered portion (644), and the first segment (640) mayimmediately transition to the second segment (642). In variations thatdo include a tapered segment (644), the tapered segment (644) mayprovide a gradual diameter transition between the first (640) and second(642) segments, which may in turn reduce the presence of edges that maycatch on or otherwise disturb tissue during use of the grasper (600).

Additionally or alternatively, the barrel portion (610) may have atapered segment (646) at a proximal end of the barrel portion (610),which may also be at a proximal end of the first segment (640). In thesevariations, the diameter of the tapered segment (646) may taper from thefirst outer diameter of the first segment (640) to a third outerdiameter smaller than that of the first outer diameter. In variationsthat include a tapered segment (646) at a proximal end of the barrelportion (610), the tapered diameter may facilitate alignment of thebarrel portion (610) with a portion of the delivery device.Specifically, when a proximal end of the barrel portion (610) isinserted into a portion of a delivery device (as described in moredetail below), the tapered segment (646) may help guide the barrelportion (610) into the delivery device, which may be beneficial ininstances where the delivery device (or another retrieval device) isconnected to the grasper to retrieve the grasper.

The first jaw (602) may be configured to rotate in any suitable mannersuch as described above. For example, in the variation of the grasper(600) shown in FIGS. 6A-6C, the grasper (600) may comprise a proximalarm (620) connected to the first jaw (602) such that rotation of theproximal arm (620) relative to the pivot point (608) rotates the firstjaw (602) relative to the pivot point (608) (which may also rotate thefirst jaw (602) relative to the main body (606) and/or the second jaw(604)). While the proximal arm (620) shown in FIGS. 6A-6C may comprise acurved arm (620) that may be configured to act as both a cam and a lever(similar to the proximal arm (220) of the grasper (200) discussed abovewith respect to FIGS. 1A-1C and 2A-2F), it should be appreciated thatthe grasper may include any of the proximal arms and/or eccentric cammembers discussed above with respect to FIGS. 3A-3B and 4A-4B. Theproximal arm (620) (and/or an eccentric cam member) may assist inactuation of the grasper (600), as described hereinthroughout.

Generally, at least a portion of the proximal arm (620) may be exposedrelative to the main body (606), which may allow a grasping device tograsp the proximal arm (620) to rotate the first jaw (602) relative tothe second jaw (604), as will be discussed in more detail below.Specifically, the main body (606) may comprise a barrel extension (660)between the barrel portion (610) and the pivot point (608). As shown ina cross-sectional side view in FIG. 6C, the barrel extension (660) maycomprise a channel (662) extending at least partially through the barrelextension (660). In the variation shown in FIGS. 6A-6C, the channel(662) may extend entirely through the barrel extension (660). The barrelextension (660) may have a wall (664) on one or both sides of thechannel (662). In the variation shown in FIGS. 6A-6C, the barrelextension (660) may have a wall (664) on each side of the channel (662).The proximal arm (620) may be positioned at least partially within thechannel (662), and may be configured to rotate through the channel (662)as the grasper (600) is actuated between open and closed configurations.

Generally, each wall (664) of the barrel extension (660) may have a topedge (666) and a bottom edge (668). The top edge (666) and bottom edge(668) may have any suitable profile, and together may define a height ofthe wall (664). For example, in the variation shown in FIGS. 6A-6C, thebottom edge (668) may be linear and substantially parallel to alongitudinal axis, while the top edge (666) may include a linear portion(680) positioned between two ramped segments (labeled (682) and (684)).In these variations, the height of the walls (664) may decrease alongeach of the ramped segments (682) and (684) toward the linear portion(680). This may facilitate grasping of the grasper (600) with a graspingdevice, as will be described in more detail below. In other variations,the top edge (666) and/or the bottom edge (668) may have a curvedprofile.

In some variations, the graspers described here may comprise a shuttlepin at least partially positioned in a lumen of the barrel portion ofthe grasper. Generally, the shuttle pin may reduce the distance anactuation rod may need to be inserted into the barrel portion in orderto actuate the grasper. For example, in the variation of the grasper(600) shown in FIG. 6C, the grasper (600) may further comprise a shuttlepin (650). The shuttle pin (650) may be positioned at least partiallywithin the lumen (612) of the barrel portion (610) of the grasper (600)and may be configured to slide relative to the lumen (612). The shuttlepin (650) may have a proximal end (652) and a distal end (654), and mayassist in actuation of the grasper (600). Specifically, advancement of aportion of a delivery device (e.g., an actuation rod) into the lumen(612) of the barrel portion (610) may cause the delivery device tocontact the proximal end (652) of the shuttle pin (650) and advance theshuttle pin (650) relative to the lumen (612). As the shuttle pin (650)is advanced relative to the lumen (612) of the barrel portion (610), thedistal end (654) of the shuttle pin (650) may press against the proximalarm (620) (or an eccentric cam member, in variations where the grasperincludes an eccentric cam member), which may cause the proximal arm(620) to act as a cam member, such as discussed in more detail above.

Without the shuttle pin (650), an actuation rod may otherwise need to beinserted into the barrel portion (610) until it contacts the proximalarm (620) directly, such as discussed above. When the delivery device iswithdrawn relative to the shuttle pin (650), the return bias of thefirst jaw (202) toward a closed configuration may push the shuttle pin(650) proximally relative to the lumen (612) of the barrel portion(610). While the variations of the graspers discussed above with respectto FIGS. 2A-2F, 3A, 3B, 4A, and 4B are not depicted as having a shuttlepin, it should be appreciated that any of these graspers may comprise ashuttle pin, which may be configured in any suitable manner as discussedwith respect to shuttle pin (650) of the grasper (600) shown in FIGS.6A-6C.

In variations where the graspers described here comprise a shuttle pin,the grasper may be configured to help prevent the shuttle pin fromdisengaging from the grasper. In some variations, at least a portion ofa shuttle pin may be configured to have an outer profile that is largerthan at least a portion of the lumen of the barrel portion of a mainbody. For example, in the variation of the shuttle pin (650) shown inFIG. 6C, the distal end (654) may comprise a cap (656) that may have anouter diameter sized to be larger than the lumen (612) of the barrelportion (610) of the main body (606). The shuttle pin (650) may bepositioned in the lumen (612) such that the cap (656) is positioneddistally of the lumen (612). Because the cap (656) is sized larger thanthe lumen (612), it may be prevented from entering the lumen (612) asthe shuttle pin (650) is slid proximally relative to the barrel portion(610). Accordingly, the shuttle pin (650) may slide proximally until thecap (656) contacts the barrel portion (610), at which point the cap(656) may act as a stop to prevent further proximal movement of theshuttle pin (650). This may prevent the shuttle pin (650) from slidingout of the proximal end of the barrel portion (610) and disengaging thegrasper (600).

Additionally, the grasper (600) may be configured to limit the amount ofdistal advancement of the shuttle pin (650). Generally, a portion of aproximal arm or an eccentric cam member (e.g., the proximal arm (620) ofgrasper (600)) may be aligned with the lumen of the barrel portion,which may resist or stop forward advancement of the shuttle pin (650)due to gravitational forces. When a delivery device or other device isused to advance the shuttle pin (650) to rotate the proximal arm and/oreccentric cam member, the delivery device and/or grasper may beconfigured to limit advancement of the shuttle pin (e.g., by blockingadvancement of the shuttle pin (650) when the grasper is opened, asdiscussed in more detail below).

In some of these variations, when a delivery device is used to advancethe shuttle pin (650), it may be configured to advance the shuttle pin apredetermined distance (e.g., about 1 cm, about 1.25 cm, about 2 cm, orthe like) to actuate the grasper (600). In these variations, the shuttlepin (650) may be sized to be longer than this predetermined distance(e.g., greater than about 2.5 cm, greater than about 3 cm, or the like),such that at least a portion of the shuttle pin (650) may remain in thelumen when fully advanced by the delivery device. In some of thesevariations, the shuttle pin may be sized with a length such that atleast a predetermined length (e.g., about 1.25 cm) of the shuttle pinremains in the lumen (612) when the shuttle pin (650) has been advancedthe predetermined distance (e.g., for an advancement distance of about1.25 cm, the shuttle pin may have a length of about 2.5 cm).

Additionally or alternatively, the grasper (600) may be configured tolimit the amount that the delivery device may advance the shuttle pin(650). For example, in some variations, a portion of the grasper (600)may be positioned in the path of the shuttle pin (650) and resistsfurther advancement of the shuttle pin (650) by the delivery device. Forexample, the pivot point (608) may be positioned along the movement pathof the shuttle pin (650). In these variations, the distal end (654) ofthe shuttle pin (650) may be stopped from further advancement by aportion of the first jaw (602) and/or the proximal arm (620) (and/or theeccentric cam member, in variations where the grasper contains aneccentric cam member) near the pivot point (608).

The grasper (600) shown in FIGS. 6A-6C may be actuated in any suitablemanner. In some variations, the grasper (600) may be configured suchthat it may be actuated by a force applied internally of the grasper(600) (e.g., via an actuation rod of a delivery device advanced throughthe lumen (612) of the barrel portion (610) of the grasper (600), asdiscussed in more detail below), and may be further configured such thatit may be actuated by a force applied externally of a grasper (600)(e.g., via a grasping device).

FIGS. 7A-7D depict cross-sectional side views of a distal portion of adelivery device (700) and a manner of actuating the grasper (600) usingthe delivery device (700). The delivery device (700) and grasper (600)may be configured for minimally invasive introduction into the body,such as described above. Specifically, the delivery device (700) maycomprise a handle (not shown), a shaft (706) extending from the handle,and a distal engagement portion (708) at a distal end of the shaft(706). The handle may comprise an actuation control mechanism that maybe manipulated by a user to controllably actuate the grasper, and may beconfigured as described above with respect to the handle (104) of thedelivery device (100) described above with respect to FIGS. 1A-1C. Insome of these variations, the actuation control mechanism may comprise atrigger.

In some of these variations, the actuation control mechanism may beconfigured to both actuate the grasper (600) and the delivery device(700). In variations where the actuation control mechanism comprises atrigger, the trigger may be moveable between three positions (althoughit should be appreciated that the trigger may assume one or moreintermediate positions between these positions). Of the three positions,the trigger may be moveable between a first position (such as theposition of the trigger (112) of the delivery device (100) shown in FIG.1A) and a second position (such as the position of the trigger (112) ofthe delivery device (100) as shown in FIG. 1B) to close and open,respectively, the grasper (600). The trigger may be moveable to a thirdposition (such as the position of the trigger (112) of the deliverydevice (100) as shown in FIG. 1C) to eject or otherwise release thegrasper (600) from the delivery device (700). In some of thesevariations, to move the trigger from the second position (in which thegrasper (600) is placed in an open configuration) to the third position(to eject the grasper (600) from the delivery device (700)), the triggermay need to be moved through the first position, thereby moving thegrasper (600) to a closed configuration prior to ejecting the grasper(600).

Returning to FIGS. 7A-7D, in some variations the distal engagementportion (708) of the delivery device (700) may comprise a couplingmagnet (718) and a spring (720). In these variations, the couplingmagnet (718) may be slidably housed in the distal engagement portion(708) (e.g., in a housing of the distal engagement portion (708)). Thecoupling magnet (718) may be moveable between an advanced position (asdepicted in FIGS. 7A-7C) and a retracted position (as depicted in FIG.7D). The spring (720) may be positioned within the distal engagementportion (708) such that the spring (720) biases the coupling magnet(718) toward the advanced position. The delivery device (700) may beconfigured to couple to the grasper (600) when the coupling magnet (718)is in the advanced position.

As described in more detail herein, at least a portion of the grasper(600) may comprise one or more materials configured to be attracted by amagnetic field. When the grasper (600) is positioned near the distalengagement portion (708) (such as shown in FIG. 7A), the coupling magnet(718) may attract the grasper (600) and temporarily couple the grasper(600) to the delivery device (700). Similarly, a visualization device(e.g., camera, light source) configured to be coupled to the deliverydevice (700) may comprise one or more materials configured to beattracted by a magnetic field. When the visualization device ispositioned near the distal engagement portion (708), the coupling magnet(718) may attract the visualization device and temporarily couple thevisualization device to the delivery device (700).

Specifically, when the grasper (600) is temporarily coupled to thedelivery device (700), at least a portion of the barrel portion (610)may be positioned within the distal engagement portion (708), as shownin FIG. 7B. The attractive force between the coupling magnet (718) andthe grasper (600) may hold the grasper (600) in place. In variationswhere the grasper (600) has a barrel portion (610) having a firstsegment (640) having a first outer diameter and a second segment (642)having a second outer diameter (e.g., FIG. 6B), the second outerdiameter may be sized to fit within the distal engagement portion (708)while the first outer diameter may be sized such that it is too large tofit within the distal engagement portion (708). In these variations, thefirst segment (640) (or a tapered segment (644) between the firstsegment (640) and the second segment (642)) may act as a stop to limitthe amount of the barrel portion (610) that may enter the distalengagement portion (708).

Similarly, as shown in FIG. 21 , a visualization device such as a camera(2100) may be configured to be temporarily coupled to the deliverydevice (700). The camera (2100) may have a capsule-like outer shape asshown, or may have any other suitable shape. The camera (2100) maycomprise a lens. The lens may be located in any suitable location, suchas but not limited to the distal end of the camera (2100), or along abarrel portion (2110) of the camera. As described in more detail herein,the camera (2100) may comprise one or more magnetic elements, which maybe located, for example, at an end of the camera or along a barrelportion. When the camera (2100) is coupled to the delivery device (700),at least a portion of the barrel portion (2110) may be positioned withinthe distal engagement portion (708), similar to as shown in FIG. 7B. Theattractive force between the coupling magnet (718) and the camera (2100)may hold the camera (2100) in place. In variations where the camera(2100) has a barrel portion (2110) having a first segment (2140) havinga first outer diameter and a second segment (2142) having a second outerdiameter, the second outer diameter may be sized to fit within thedistal engagement portion (708) while the first outer diameter may besized such that it is too large to fit within the distal engagementportion (708). In these variations, the first segment (2140) (or atapered segment (2144) between the first segment (2140) and the secondsegment (2142)) may act as a stop to limit the amount of the barrelportion (2110) that may enter the distal engagement portion (708).

It should be appreciated that in some variations the proximal end of thegrasper may comprise a magnetic element used with a control element tomaneuver the grasper, for example, as described below with respect toFIGS. 8A-12C, 18A-18B, and 19A-19B. In these variations, the magneticelement in the proximal end of the grasper may also be used to attractthe distal engagement portion of the delivery device and couple thegrasper and the delivery device. In some variations of a visualizationdevice such as a camera and/or light source configured to reversiblycouple to the delivery device, a proximal end of a visualization devicemay comprise a magnetic element. In these variations, the magneticelement in the proximal end of the visualization device may also be usedto attract the distal engagement portion of the delivery device andcouple the visualization device and the delivery device. This magneticelement is also described in more detail with respect to use of acontrol element to maneuver the visualization device, for example, asdescribed below with respect to FIGS. 5E, 12D, and 18C-18D.

Additionally, the delivery device may comprise a coupling magnet, butneed not. When the delivery device does not comprise a coupling magnet,a distal engagement portion of the delivery device may comprise acoupling element comprising a ferromagnetic or ferrimagnetic materialthat is slidably housed in the distal engagement portion. The couplingelement may be configured to move between an advanced position and aretracted position, where the delivery device is configured to couple tothe grasper (or visualization device) via attractive force between themagnetic element in the grasper and the coupling element when thecoupling element is in the advanced position.

In order to decouple the grasper (600) from the distal engagementportion (708), the coupling magnet (718) may be withdrawn to theretracted position, such as shown in FIG. 7D. As the coupling magnet(718) is retracted, the attractive force between the coupling magnet(718) and the grasper (600) may move the grasper (600) proximallyrelative to the distal engagement portion (708). The first segment (640)(or the tapered segment (644)) may limit the movement of the grasper(600) into the distal engagement portion (708), such that the distancebetween the coupling magnet (718) and the grasper (600) increases. Thismay decrease the attractive force between the coupling magnet (718) andthe grasper (600), which may allow the grasper (600) to be pulled from,released from, or otherwise fall from the distal engagement portion(708).

The coupling magnet (718) may be retracted in any suitable manner, suchas described in more detail above. For example, in the variation of thedelivery device (700) shown in FIGS. 7A-7D, the delivery device (700)may comprise an actuation rod (714) slidably disposed in the shaft(706). The actuation rod (714) may be configured to retract the couplingmagnet (718). For example, the actuation rod (714) may be slidablydisposed within a lumen (722) of the coupling magnet (718). In somevariations, at least a segment of the actuation rod (714) may be sizedand configured such that the portion of the actuation rod (714) cannotfully pass through the lumen (722). For example, the variations in FIGS.7A-7D show a segment (740) of the actuation rod that may have a diametergreater than a diameter of the lumen (722).

Additionally or alternatively, the segment (740) may comprise one ormore projections extending from an outer surface of the actuation rod(714) and which cannot fully pass through the lumen (722). When thesegment (740) of the actuation rod (714) is positioned distal to thecoupling magnet (718), the actuation rod (714) may be freely advancedrelative to the coupling magnet (718). Conversely, withdrawal of theactuation rod (714) may pull the segment (740) of the actuation rod(714) into contact with the coupling magnet (718). Since the segment(740) cannot fully pass through the lumen (722) of the coupling magnet(718), further withdrawal of the actuation rod (714) may cause thesegment of the actuation rod (714) to pull on and withdraw the couplingmagnet (718). When the actuation rod (714) is subsequently advanced, thespring (720) may advance the coupling magnet (718) with the actuationrod (714) until the coupling magnet (718) reaches the advanced position.

The actuation rod (714) may be advanced or retracted relative to theshaft (706) to actuate and/or eject the grasper (600). In variationswhere the handle comprises a trigger (such as discussed above), thetrigger may be operatively connected to the actuation rod (714), suchthat movement of the trigger slides the actuation rod (714). Movement ofthe actuation rod (714) may rotate the first jaw (602) of the grasper(600). Specifically, when the grasper (600) is coupled to the deliverydevice (700) (as shown in FIG. 7B), the actuation rod (714) may bealigned with the lumen (612) of the barrel portion (610) such that theactuation rod (714) enters the lumen (612). As the actuation rod (714)is advanced into the lumen (612), the actuation rod (714) may pressagainst the proximal end (652) of the shuttle pin (650) and advance theshuttle pin (650) along the lumen (612). As the shuttle pin (650) isadvanced along the lumen (612), the distal end (654) of the shuttle pin(650) may move into the channel (662) of the barrel extension (660). Thedistal end of the shuttle pin (650) may in turn push against theproximal arm (620) (e.g., against a portion of the proximal arm (620)that is positioned in the channel (662) and aligned with the lumen(612)). The proximal arm (620) may act as a cam to convert the linearmotion of the shuttle pin (650) into rotation of the proximal arm (620),which may in turn rotate the first jaw (602) away from the second jaw(604). When the first jaw (602) is spring-biased toward the second jaw(604), the rotation of the proximal arm (620) may overcome this springbias, which may allow the actuation rod (714) to hold the first jaw(602) in its open position, as shown in FIG. 7C.

Additionally, the first jaw (602) may rotate back toward the second jaw(604) when the actuation rod (714) is retracted. Specifically, as theactuation rod (714) is withdrawn, the return bias of the first jaw (602)may cause the proximal arm (620) to push against the shuttle pin (650),which may slide the shuttle pin (650) proximally within the lumen (612).This may return the grasper (600) to a closed configuration, such asshown in FIG. 7B. When the grasper (600) is closed around tissue, theactuation rod (714) may be further retracted to release the grasper(600) from the delivery device (700), as discussed above. When a triggeris moveable between three positions to actuate and release the grasper(600) as discussed above, placing the trigger in the first position mayposition the actuation rod (714) in a position as illustrated in FIG.7B, in which the grasper (600) may be coupled to the delivery device(700) in a closed configuration. Moving the trigger to the secondposition may advance the actuation rod to the position illustrated inFIG. 7C, in which the grasper (600) may be releasably coupled to thedelivery device (700) in an open configuration. Moving the trigger tothe third position may retract the actuation rod (714) to the positionillustrated in FIG. 7D, in which the grasper (600) may be decoupled fromthe delivery device (700).

Additionally, in the variation of the grasper (600) shown in FIGS.6A-6C, at least a portion of the proximal arm (620) may be exposedrelative to the main body (606) (e.g., at least a portion of theproximal arm (620) may extend out of the channel (662) of the barrelextension (660)), which may allow a grasping device to grasp theproximal arm (620) to rotate the first jaw (602) relative to the secondjaw (604). For example, opposing forces (represented by arrows (622) inFIG. 6C) may be applied (e.g., via a grasping device) to the exposedportion of the proximal arm (620) and the main body (606) (e.g., thebarrel extension (660)) to cause the proximal arm (620) to rotate aroundthe pivot point (608) (which may, in turn rotate the first jaw (602)away from the second jaw (604)). In these variations, the height of thewalls (664) of the barrel extension (660) may limit the amount that theproximal arm (620) may be rotated (e.g., a grasping device may rotatethe proximal arm (620) until the grasping device contacts the top andbottom edges of the wall).

Additionally or alternatively, when the top and/or bottom edges of awall of the barrel portion are curved or ramped, the curved or rampededges may help guide a grasping device toward another section of thebarrel extension (660) during grasping. Specifically, if the graspingdevice applies a compressive force at a ramped or curved portion of anedge, the grasping device may slide along the ramped/curved portiontoward a shorter portion of the wall. For example, in the variation ofthe grasper (600) shown in FIGS. 6A-6C, if a grasping device applies acompressive force at either the ramped segments (682) or (684) of thetop edge (666), the grasping device may slide toward the linear portion(680).

2. Grasper

As mentioned above, the graspers described herein may comprise a firstjaw and a second jaw, and at least one of the first jaw and the secondjaw may be configured to rotate relative to the grasper to actuate thegrasper between an open configuration and a closed configuration. Thejaws may be configured in the closed configuration to secure tissue. Insome variations, the graspers may be configured to secure tissue byengaging the tissue between a grasping surface of each of the two jaws(e.g., gripping, squeezing, compressing, etc. the tissue between the twojaws). That is, the jaws may be configured to hold tissue between twosurfaces that would be in contact in the closed configuration but forthe tissue between the surfaces. In these variations, the jaws of thegraspers may comprise one or more features which may promote engagementwith tissue. In some variations, one or more surfaces of a jaw may beroughened, which may help to reduce slipping between the jaws andtissues.

Additionally or alternatively, the graspers may comprise teeth or otherprojections which may facilitate engagement of the jaw with tissue. Forexample, in the variation of the grasper (600) shown in FIGS. 6A-6C, thefirst jaw (602) and the second jaw (604) may each include a graspingsurface (690) having a plurality of teeth (692). In a closedconfiguration, the grasper (600) may be configured to engage tissuebetween the teeth (692) of the grasping surfaces (690). In variations inwhich the grasper (600) is biased toward the closed configuration, thecombination of the size, shape, and features (e.g., teeth) of thegrasper (600), as well as the biasing force (e.g., due to a torsional orcantilever spring), may be chosen to produce a desired grasping force onthe tissue. It may in some instances be desirable for the grasping forceto allow the delivery device to be decoupled from the grasper (600) andto allow the tissue to be held securely during a procedure, while notcausing tissue damage.

In other variations, instead of or in addition to squeezing the tissuebetween contact surfaces, the graspers may be configured to surroundtissue in a space formed between the two closed jaws. That is, the jawsmay be configured such that in a closed configuration, there is a spacebetween the jaws (even when no tissue is located between the jaws). Thisspace may be used to hold at least a portion of tissue. As such, lessforce may be applied to tissues during grasping. This may be desirablefor use with particular types of tissues (e.g., a portion of tissuehaving a tubular or elongate shape) and in particular procedures, suchas but not limited to reconstructive laparoscopy (e.g., colon,bariatric). In some variations, the graspers may be configured to holdtissue only within the space between the jaws, and not to compresstissue between two contact surfaces. In other variations, the graspersmay be configured such that a first portion of tissue may be held withinthe space between the jaws, and a second portion of tissue may becompressed between the contact surfaces of the jaws.

FIGS. 13A-16 show exemplary graspers configured to surround tissue in aspace between two closed jaws. FIGS. 13A-13C, for example, depict side(FIG. 13A) and perspective (FIGS. 13B-13D) views of a grasper (130)) inclosed (FIGS. 13A-13B) and open (FIGS. 13C-13D) configurations. Grasper(1300) comprises a first jaw (1302), a second jaw (1304), and a mainbody (1306). First jaw (1302) may comprise a distal contact surface(1312) (labeled in FIG. 13C), which may face a distal contact surface(1314) of the second jaw (1304). Generally, the first jaw (1302) may berotatably connected to the main body (1306) at a pivot point (1308),such that the first jaw (1302) may be able to rotate relative to themain body (1306). While the second jaw (1304) is shown in FIGS. 13A-13Cas being fixed relative to the main body (1306), it should beappreciated that in some variations the second jaw (1304) may berotatably connected to the main body (1306).

The first jaw (1302) (and/or the second jaw (1304) in variations inwhich the second jaw (1304) is rotatably connected to the main body(1306)) may be rotated relative to the main body (1306) to actuate thegrasper (1300) between an open configuration and a closed configuration.In the closed configuration, the first jaw (1302) and second jaw (1304)may be rotated toward each other such that the contact surfaces (1312,1314) are touching. This may allow the first and second jaws (1302) todefine an enclosed space (1316) between the two jaws (1302, 1304). Thespace (1316) between the two jaws may be configured to contain tissue.In the open configuration, the first jaw (1302) and the second jaw(1304) may be held in rotationally separated positions to define a spacebetween the distal contact surfaces (1312, 1314), which may allow tissueto enter the space between the first and second jaws (1302, 1304). Thefirst and second jaws (1302, 1304) may be rotationally biased toward aclosed configuration in any suitable manner (e.g., via a torsionalspring, not shown).

In some variations, the portion of the grasper (1300) proximal to thepivot point (1308) may have the same configuration as grasper (600), andthe grasper (1300) may be delivered and actuated between the open andclosed configurations using a delivery device as described above withrespect to FIGS. 6A-7D. In some variations, the grasper (1300) maycomprise features configured to promote secure engagement between thetwo distal contact surfaces (1312, 1314) in the closed configuration,and/or to promote engagement with tissue. For example, the contactsurfaces may comprise teeth, grooves, ridges, or the like to promotesecure engagement, which may help to keep any tissue enclosed in thespace between the jaws from slipping between the contact surfaces, ormay help to hold onto any tissue gripped, squeezed, etc. between thecontact surfaces.

In variations in which the graspers are configured to surround tissue ina space between the two closed jaws, the space may have any suitableshape. In some variations, the jaws may form an elongate space extendingfrom near the pivot point to the contact surface, as shown for examplein FIGS. 13A-13B, where the jaws (1302, 1304) of a grasper (1300) form aspace (1316) from the pivot point (1308) to the contact surfaces (1312,1314).

Another example is shown in FIGS. 14A-14D, which depicts side (FIGS.14A-14B) and perspective views (FIGS. 14C-14D) of grasper (1400) inclosed (FIGS. 14A and 14C) and open (FIGS. 14B and 14D) configurations.A grasper (1400) may comprise a first jaw (1402), a second jaw (1404),and a main body (1406) having the same features as grasper (1300)described herein, including a space (1416) formed by the first andsecond jaws when in the closed configuration. The space (1416) mayextend from the pivot point (1408) to the contact surfaces (1412, 1414).

As can be seen in comparing graspers (1300) and (1400), the jaws mayhave any suitable length. Whereas the pivot point (1308) in grasper(1300) is located approximately in the middle of grasper (1300), thepivot point (1408) in grasper (1400) is located closer to the distalend; that is, the jaws are shorter in grasper (1400) and form a shorterspace (1416). Particular jaws designs may be desirable in order tocreate spaces of particular sizes (e.g., in order to hold particulartissues). It may also be desirable for the jaws to have differentshapes. While the grasper (1300) in FIGS. 13A-13C comprises first andsecond jaws (1302, 1304) that slightly taper toward the distal end ofthe jaws (best shown in FIG. 13C), in other variations the jaws may havea uniform width from their proximal to distal ends. For example, FIG.13D shows a grasper (1300′), which has first and second jaws (1302′,1304′) having a uniform width from their proximal to distal ends.

In other variations, the jaws may be configured to form a space only atthe distal end of the jaws and not between a pivot point and the distalend. For example, FIGS. 15A-15D show a grasper (1500) having a first jaw(1502), a second jaw (1504), and a main body (1506) having similarfeatures as grasper (1300) described herein, including a space (1516)between the closed jaws (1502, 1504). However, unlike grasper (1300),the first and second jaws (1502, 1504) may contact each otherimmediately distal to the pivot point (1508). Thus, the space (1516) islocated closer to the distal end of the jaws (1502, 1504), and extendsfrom an intermediate location along the jaws (1502, 1504) to the contactsurfaces (1512, 1514). Particular locations of the space (1516) relativeto the rest of the grasper (1500) may be desirable to control thedistance between tissues. For example, when the grasper is locatedwithin a body cavity and a magnetic field of an external control elementholds the grasper in a perpendicular configuration with the proximal endof the grasper body against the cavity wall, the location of the space(1516) along the jaws (1502, 1504) may determine the distance of thetissue held in the space to the cavity wall.

In some variations, one or more jaws of the graspers described here mayinclude a longitudinal recess extending at least partially through thejaws. With reference to FIG. 6C for example, grasper (600) may include arecess (694) extending at least partially through the grasping surface(690) and some of the teeth (692). Similarly, graspers (1300), (1400),and (1500) may include recesses (1394), (1494), and (1594),respectively, extending at least partially through each of first andsecond jaws (1302, 1304), (1402, 1404) and (1502, 1504), respectively.In these variations, when the jaws are used to grasp tissuetherebetween, tissue may be squeezed or captured into or otherwise enterthe recess of each jaw, which may help to provide a more secure holdbetween the grasper and the tissue. The size and placement of therecesses may also influence the effect of a magnetic field on thegraspers, as described in more detail below.

In some variations of the graspers described here, the grasper maycomprise one or more coatings which may help to smooth discontinuitiesin the contours of the grasper and may act to provide one or moreatraumatic surfaces of the grasper. The one or more coatings maycomprise silicone, urethane, one or more nylon blends, polyethylenes,fluoropolymers, combinations thereof and the like. It may also bedesirable to use certain coatings and/or materials in or on all or aportion of the grasper in order to reduce the occurrence of unintendedelectrical current flowing through the grasper. For example, in asurgical procedure involving electrical current (e.g., electrocautery),if the grasper contacts an electrocautery instrument, the electricalcurrent may flow through the grasper and cause cauterization of, orburns in, the various tissues touching the grasper. This cauterizationor burning of the tissue may be unintended and/or undesirable. Thus,non-conducting materials and/or coatings may be used on all or a portionof the grasper (e.g., a portion of the grasper closest to the surgicalsite) to reduce or eliminate the flow of electrical current through thegrasper and thus reduce the likelihood that tissue may be damagedunintentionally by electrical current. For example, and as described inmore detail below, in some variations, one of the jaws of a grasper(such as any of the graspers described herein) may be made ofnon-conducting material. Additionally or alternatively, the distalportion of one or both of the jaws of a grasper (such as any of thegraspers described here) may be made of a non-conducting material. Anysuitable non-conductive material (e.g., plastic, or the like) and/ornon-conductive coating (e.g., paints, plastic tubing, co-moldedthermoplastic elastomers, a combination thereof, or the like) may beused. In some instances, materials used for non-conductive propertiesmay be the same as those used for non-magnetic properties (e.g.,plastic), which are described in more detail below.

B. Maneuvering the Grasper

As mentioned above, the graspers described here may be used to provideremote manipulation of tissue during a minimally-invasive procedure.During such a procedure, it may be desirable to maneuver and/or controlthe grasper using one or more elements located outside of the body(e.g., one or more control elements), so that the delivery devicesdescribed here may be withdrawn, and the access ports may be utilizedfor other tools and/or instruments. It may also be desirable to maneuveranother tool, such as a visualization device (e.g., camera, lightsource) using one or more elements located outside of the body (e.g.,one or more control elements), so that the position and/or orientationof the visualization device can be controlled without occupying anaccess port.

Maneuvering and/or controlling the grasper using one or more elementslocated outside the body, and not through a physical connection via anaccess port, may additionally or alternatively allow for force to beapplied to the grasper (and in turn to tissue) in a direction differentfrom the direction of force that may be applied through an access port.This may allow force to be applied to the grasper (and in turn totissue) in a greater number of directions. Additionally oralternatively, maneuvering and/or controlling the grasper using one ormore elements located outside the body, and not through a physicalconnection via an access port, may allow for improved visualization of aregion of interest. In some variations, it may be desirable to controlan orientation of the grasper using one or more elements located outsideof the body (e.g., one or more control elements) to increasemaneuverability and control of the grasper.

Generally, the graspers and/or visualization devices may be maneuveredusing one or more attractive and/or repulsive forces. Specifically, thegraspers and/or visualization devices may be configured to be attractedto and/or repelled by one or more magnetic elements positionedexternally of the body. Attractive and/or repulsive forces originatingfrom outside the body may be used to move, reposition, and/or hold thegrasper and/or visualization device. These forces may in turn move,hold, and/or provide traction for the tissue held by the grasper. Insome instances, it may be desirable to configure the grasper and/orvisualization device and the control element such that their magneticattributes and/or those of the control element do not affect otherinstruments that are not intended to be part of the magneticallycontrolled grasping system described herein.

The graspers described here may generally comprise a combination ofmaterials having different magnetic behavior. Varying the type ofmaterials in the grasper, where they are located in and/or on thegrasper, and the configuration of those materials, may serve severalpurposes. Generally, the arrangement of non-magnetic, ferromagnetic,ferrimagnetic, and/or diamagnetic materials within an instrument mayalter the behavior of the instrument when it is exposed to a magneticfield. The use of a combination of these materials may provide increasedcontrol over the movements of the grasper and the tissue held within itsjaws, as compared to a grasper made from only one type of material. Theconfiguration of the materials within the grasper—for example, the type,amount, polarity, and location of the materials—may alter how thegrasper responds to and/or interacts with a control element. It shouldbe appreciated that the types, location, and configuration of materialswith respect to graspers described herein may also be implemented withrespect to visualization devices such as cameras and/or light sources asappropriate to affect the behavior of the tool when exposed to amagnetic field. The use of combinations of materials may similarlyprovide increased control, for example, over the movements of a cameraand the orientation of its field of view.

For example, using both magnetic and non-magnetic materials may affectwhich portions of the grasper or visualization device (e.g., camera,light source) are attracted to, unaffected by, or repelled by magneticfields generated by the control element (and may affect which portionsof the grasper or visualization device may create magnetic fields thatmay attract, not affect, or repel portions of the control element).

As another example, increasing the amount of magnetic material locatedin a specific portion of the grasper or visualization device (e.g.,camera, light source) may increase the attractive or repulsive forcebetween that portion of the grasper/visualization device and a controlelement. Similarly, removing magnetic material from a specific portionof the grasper or visualization device and replacing it with anon-magnetic material may decrease the attractive or repulsive forcebetween that portion of the grasper/visualization device and the controlelement. Varying the type of materials and where they are located mayalso modify the distribution of the mass of the grasper or visualizationdevice, which may contribute to a user's ability to control and maneuverthe grasper or visualization device. As mentioned above, this mayprovide for better control over the grasper and the tissue within itsjaws, as described in more detail below.

As another example, the response of a grasper to an applied magneticfield may also be altered by removing material entirely to leave an airgap (in instances where the material is not required for the grasper tohold tissue as desired). With reference to FIG. 6C for example, grasper(600) may include a recess (694) extending at least partially throughthe grasping surface (690) and some of the teeth (692) of the first jaw(602). In variations in which the jaws (602, 604) comprise a materialattracted to a magnetic field, when a magnetic field is applied tograsper (600), a greater force may be generated on the second jaw (604)than the first jaw (602), since the second jaw (604) comprises morematerial. As a result, when the grasper (600) is located in a bodycavity and controlled by a magnetic field from an external controlelement, the grasper (600) may have an increased tendency to lieparallel to the cavity wall with the second jaw (604) against the cavitywall.

The recess may have any suitable configuration or placement. Forexample, FIG. 16 depicts a grasper (1600) comprising a first jaw (1602)having a recess (1694) extending through and along the length of thefirst jaw, a second jaw (1604) not having a recess, and a main body(1606). In variations in which the jaws (1602, 1604) comprise a materialattracted to a magnetic field, when a magnetic field is applied to thegrasper (1600), a greater force may be generated on the second jaw(1604) than the first jaw (1602), since the second jaw (1604) comprisesmore material. As a result, under application of a magnetic field, thegrasper (1600) may have an increased tendency to lie parallel to thecavity wall with the second jaw (1604) against the cavity wall.

As another example, graspers (1300), (1400), and (1500) shown in FIGS.13A-13D, 14A-14D, and 15A-15D may comprise recesses (1394), (1494), and(1594), respectively, extending through and along the length of each ofthe first and second jaws. As a result, in variations in which the jawsand body of the graspers are made from a material attracted to amagnetic field, when a magnetic field is applied to graspers, a greaterforce may be generated on the main bodies (1306), (1406), and (1506) ofthe graspers than on the jaws. As a result, when the graspers arelocated in a body cavity and controlled by a magnetic field from anexternal control element, the graspers may have an increased tendency tolie perpendicular to the cavity wall, with the bodies of the graspersagainst the cavity wall.

Additionally or alternatively, employing both magnetic and non-magneticmaterials may allow for control over the grasper from outside the bodywhile decreasing the likelihood that other surgical instruments will beattracted to and/or will stick to the grasper. These other instruments,when attracted to and/or stuck on the grasper, may interfere with theability to execute fine motions that may be required during a surgicalprocedure, and may cause delays during surgical procedures caused by theneed to separate surgical instruments that may have been inadvertentlyattracted to and/or become stuck on the grasper. To reduce theseundesired effects, parts of the grasper may for example be composed ofnon-magnetic materials (e.g., 300-series stainless steel, plastic, orthe like) and/or be coated with a non-magnetic coating, including butnot limited to, non-magnetic paints, plastic tubing, co-moldedthermoplastic elastomers, a combination thereof, and the like. Thesenon-magnetic materials and/or coatings may reduce or eliminate theattraction between the grasper and other instruments, while maintainingthe ability to control the grasper from outside the body.

For example, in some variations a portion of the grasper may be madefrom plastic (e.g., both jaws, one jaw, a distal portion of one or bothjaws, a proximal portion of one or both jaws, a combination thereof, orthe like) while the remainder of the grasper may comprise aferromagnetic material. In these variations, the plastic portion of thegrasper will not attract surgical tools, but the grasper may still becontrolled using an external control element.

In variations in which a non-magnetic coating may be applied to amagnetic material, the coating may increase the distance between themagnetic material and the surgical instruments, and may prevent closecontact between the magnetic material and the instruments. This maydecrease the attractive force between the coated portion of the grasperand the surgical instruments, but may still allow the grasper to becontrolled by an external control element. In some instances, it may bedesirable to use non-magnetic materials and/or coatings on the portionof the grasper closest to the surgical site (e.g., all or a portion ofthe jaws, such as a proximal portion); however, such materials and/orcoatings may be utilized at any location on the grasper that does notinterfere with the control of the grasper or the coupling of thedelivery devices using a coupling magnet, as described above. Generally,thicker coatings will decrease the force between the grasper and theother instruments, and coatings of any suitable thickness may be used toachieve a desired force profile. In some variations, it may also bepossible to use diamagnetic materials and/or coatings to reduce thelikelihood that other surgical instruments will be attracted to and/orwill stick to the grasper. A visualization device such as a cameraand/or light source may also be in part composed of non-magneticmaterials and/or comprise a non-magnetic coating for similar reasons.

The control elements described here may optionally comprise acombination of magnetic and non-magnetic materials. The configuration ofthe magnetic and non-magnetic materials within the control element, forexample, the size, type, quantity, polarity, and location of thematerials, may alter the behavior of the grasper or visualization device(e.g., camera, light source). The control elements described here mayalso have a surface that, in use, may be placed on or near an externalsurface of a patient's body cavity and that may be parallel to theexternal surface of the patient's body cavity. The grasper and thecontrol element may be configured to yield a desired grasper positionand/or movement within the body. For example, in some variations, thecontrol element and the grasper may be configured to rotate, move,and/or hold the grasper such that it is in a perpendicular configurationrelative to the internal wall of the patient's body cavity or thesurface of the control element, i.e., with its longitudinal axistransverse to, and in some instances, substantially perpendicular to,the surface of the cavity wall or of the control element. Similarly, avisualization device (e.g., camera, light source) and control elementmay be configured to yield a desired visualization device positionand/or movement within the body. For example, the control element andvisualization device may be configured to rotate, move, and/or hold thevisualization device such that it is in a perpendicular configurationrelative to the internal wall of the patient's body cavity or thesurface of the control element, i.e., with its longitudinal axistransverse to, and in some instances, substantially perpendicular to,the surface of the cavity wall or of the control element.

In other variations, the control element and the grasper may beconfigured to rotate, move, and/or hold the grasper in a parallelconfiguration, i.e., in a configuration in which its longitudinal axisextends in the same direction as, or in some instances, is substantiallyparallel to, the surface of the cavity wall or of the control element.In some instances, the control element and the grasper may be configuredto rotate, move, and/or hold the grasper such that its longitudinal axisforms an angle between about 5 and about 85 degrees with the surface ofthe cavity wall or of the control element. In some instances, thecontrol element and the grasper may be configured to move the jaws ofthe grasper while maintaining the positioning of the proximal end of thegrasper. Similarly, in other variations, the control element and avisualization device (e.g., camera, light source) may be configured torotate, move, and/or hold the visualization device in a parallelconfiguration, i.e., in a configuration in which its longitudinal axisextends in the same direction as, or in some instances, is substantiallyparallel to, the surface of the cavity wall or of the control element.In some instances, the control element and the visualization device maybe configured to rotate, move, and/or hold the visualization device suchthat its longitudinal axis forms an angle between about 5 and about 85degrees with the surface of the cavity wall or of the control element.

As mentioned above, the graspers (and visualization device, such as acamera and/or light source) and control elements described here comprisemagnetic elements. Generally, at least one of the elements in either thegrasper (or visualization device) or the control element comprises apermanent magnet, an electromagnet, or an electro-permanent magnet. Theremaining magnetic elements in the graspers (or visualization devices)and control elements may comprise permanent magnets, electromagnets, orelectro-permanent magnets, and/or may comprise other materials that areattracted to, and/or repelled by a magnetic field, including, but notlimited to ferromagnetic materials, ferrimagnetic materials, diamagneticmaterials, a combination thereof, and the like. In some variations boththe grasper (or visualization device) and the control element maycomprise one or more permanent magnets. For example, they may bothcomprise permanent magnets oriented such that the dissimilar poles ofthe magnets attract each other when the grasper (or visualizationdevice) and control element are in the desired configurations. However,the grasper (or visualization device) and control element need not bothcomprise permanent magnets. For example, in some variations, the grasper(or visualization device) may comprise a magnetic element comprising aferromagnetic or ferrimagnetic material (e.g., iron, cobalt, nickel, andthe like) that is attracted to a magnetic field but does notindependently generate a magnetic field, and the control element maycomprise a magnetic element (e.g., a permanent magnet) that generates amagnetic field that attracts the ferromagnetic or ferrimagneticmaterial.

In some surgical procedures, or at times during a surgical procedure, itmay be desirable for the grasper to move to and/or be held in aperpendicular or angled configuration with respect to the controlelement and/or the wall of a patient's body cavity (e.g., an abdominalcavity). FIG. 8A depicts a cross-sectional side view of a variation of agrasper (800) configured to be used with a control element locatedoutside of the body to place the grasper in a perpendicular orientationrelative to the cavity wall, and FIG. 8B depicts a variation of a systemcomprising a control element (816) and the grasper (800) of FIG. 8Apositioned in a perpendicular configuration relative to the body cavity.

As shown in FIG. 8A, the grasper (800) may comprise a first jaw (802)rotatably coupled to a main body (806), a second jaw (804) fixedrelative to the main body (806), a proximal end (810), a distal end(808), a longitudinal axis (814), and a magnetic element (812). In thisvariation, the magnetic element (812) may be located in or on the mainbody (806) at a proximal end (810) of the grasper (800). When thegrasper (800) is exposed to a magnetic field generated by a controlelement (816) comprising a magnet, the proximal end (810) of the grasper(800) may be attracted to the control element (816). The remainder ofthe grasper (800) (aside from the magnetic element), including, forexample, the remainder of the main body (806) and the first and secondjaws (802, 804), may in some instances comprise a non-magnetic material.In other instances, all or a portion of the remainder of the main body(806) and the first and second jaws (802, 804) may comprise a secondmagnetic element that experiences a repulsive force when placed close tothe control element (816), for example, a diamagnetic material (e.g.,copper, zinc, lead, and the like) or a permanent magnet having apolarity causing it to be repelled by the control element.

Turning back to FIG. 8A, in the embodiment shown there, the magneticelement (812) may comprise a magnet with north and south poles orientedaxially within the grasper (800) such that the poles are positionedalong the longitudinal axis (814) of the grasper (800). Moreparticularly, the south pole (represented by the letter “S” throughoutthe figures) of the magnetic element (812) faces a proximal end of thegrasper (800) and the north pole (represented by the letter “N”throughout the figures) faces a distal end of the grasper (800). FIG. 8Bdepicts the grasper (800) of FIG. 8A in use with a control element (816)comprising a longitudinal axis (820). Shown them is a cross-sectionalside view of the cavity wall (822), the grasper (800) located within thebody, and the control element (816) located outside of the body. Thecontrol element (816) is depicted as a magnet comprising poles that facetoward and away from the cavity wall (822). As depicted, the north poleof the control element (816) faces downward, or toward the cavity wall(822), and the south pole of the control element (816) faces upward, oraway from the cavity wall (822). While the control element (816) isdepicted as a magnet itself, it need not be. In some variations, thecontrol element (816) may comprise a combination of one or morenon-magnetic materials (e.g., plastics, paramagnetic materials such astitanium, and the like) and one or more magnets.

As depicted in FIG. 8B, the attractive forces between the controlelement (816) and the magnetic element (812) may move the proximal end(810) of the grasper toward the control element (816). Morespecifically, the south pole of the magnetic element (812) in thegrasper (800) may be attracted to the north pole of the control element(816). The attractive forces between the magnetic element (812) in thegrasper (800) and the control element (816) may cause the proximal end(810) of the grasper (800) to be attracted to and move toward thecontrol element (816) and the cavity wall (822), while the distal end(808) of the grasper (800) may be repelled by and move away from thecontrol element (816) and the cavity wall (822).

Accordingly, the attractive forces between the magnetic element (812)and the control element (816) may cause the grasper (800) to rotateand/or move into a position in which its longitudinal axis (814) istransverse, and substantially perpendicular to, the surface of thecavity wall (822). In this position, the first and second jaws (802,804) of the grasper may be facing posteriorly (i.e., inward toward thebody) and away from the cavity wall (822). Additionally, if the controlelement (816) is moved relative to the cavity wall (822) (e.g., movingthe control element (816) along the exterior of the body), the grasper(800) may be moved relative to the cavity wall by a corresponding amountby the attractive forces between the magnetic element (812) and thecontrol element (816).

In some variations, the grasper (800), magnetic element (812), and thecontrol element (816) may be configured such that the attractive forcesbetween the magnetic element (812) and the control element (816) causethe grasper (800) to rotate and/or move into a position in which thelongitudinal axis (814) of the grasper (800) is located at an angle thatis less than 90 degrees with respect to the surface of the cavity wall(822). It should be appreciated that in use there may be many variablesthat may affect the angular orientation of the graspers described herewith respect to a cavity wall, including but not limited to, thelocation, number, orientation and strength of the magnetic elements inthe grasper and the control element, the material of the grasper,gravity, and/or the tension force from organs or other tissue held bythe grasper. The grasper (800) and the control element (816) may beconfigured to have an attractive force between them that places thegrasper in a desired angular orientation considering these variables.

In some variations, the material used to fabricate the grasper mayitself be the magnetic element. For example, the graspers (900A, 900B)depicted in FIGS. 9A and 9B are similar to the grasper (800) of FIG. 8A,except that the magnetic element (912A, 912B) of the graspers (900A,900B) in FIGS. 9A and 9B is the material used to create a portion of thegrasper (900A, 900B). Put another way, the material used to create aportion of the grasper (900A, 900B) may be attracted to a portion of thecontrol element (e.g., control element (916) in FIG. 9C). As such, thecontrol element (916) may be used to control and/or maneuver the grasper(900A, 900B). As depicted in FIGS. 9A and 9B, the graspers (900A, 900B)may comprise a first jaw (902A, 902B), a second jaw (904A, 904B), a mainbody (906A, 906B), a longitudinal axis (914A, 914B), a distal end (908A,908B), a proximal end (910A, 910B), and a magnetic element (912A, 912B).

In some instances, the grasper may comprise a magnetic element and oneadditional material, while in other variations the grasper may comprisea magnetic element and multiple additional materials. For example, FIG.9A depicts a grasper (900A) comprising a magnetic element (912A), asecond material (924A), a main body (906A), and first and second jaws(902A, 904A). In this variation, the magnetic element (912A) may be thematerial of the main body (906A) and a proximal portion of the first andsecond jaws (902A, 904A), while a distal portion of the first and secondjaws (902A, 904A) may be a second material (924A). In some instances,the first magnetic element (912A) may be a ferromagnetic material (e.g.,400-series stainless steel or the like) and the second material (924A)may comprise a non-magnetic material (e.g., 300-series stainless steel,plastic or the like).

In some variations, more or less of the grasper may be made from themagnetic element (912A) (e.g., any portion of the main body (906A)and/or more or less of the proximal portion of the first and second jaws(902A 904A)). For example, in some instances, the top half of thegrasper (i.e., the portion above the longitudinal axis (914A)) may bemade from the magnetic element (912A), while the bottom half of thegrasper (i.e., the portion below the longitudinal axis (914A)) may bemade from a non-magnetic material. As another example, one jaw may bemade from a non-magnetic material, while the other jaw may be madepartially from a ferromagnetic material and partially from anon-magnetic material (e.g., a distal end may be made from anon-magnetic material). In some of these instances in which one jaw isrotatable relative to the main body and one jaw is fixed relative to themain body, the rotatable jaw may be made from a non-magnetic material,while the fixed jaw may be made partially from a ferromagnetic materialand partially from a non-magnetic material. For example, with referenceto FIG. 9A, first jaw (902A) may be made from a non-magnetic material,while second jaw (904A) may be made partially from a ferromagneticmaterial and partially from a non-magnetic material. More particularly,in some variations the distal end of the second jaw (904A) may be madefrom a non-magnetic material, while the remainder of the second jaw(904A) proximal to the distal end may be made from a ferromagneticmaterial. It should be appreciated that in other instances in which onejaw is rotatable relative to the main body and one jaw is fixed relativeto the main body, the fixed jaw may be made from a non-magneticmaterial, while the rotatable jaw may be made partially from aferromagnetic material and partially from a non-magnetic material. Insome cases, non-magnetic material may also be replaced with a recess, asdescribed in more detail above. In still other variations, the secondmaterial (924A) may be a material that experiences a repulsive forcewhen exposed to the control element (916).

In some instances, and as depicted in FIG. 9B, a proximal portion of thegrasper (900B) may comprise a magnetic element (912B), a central portionof the grasper (900B) may comprise a second material (924B), and adistal portion of the grasper (900B) may comprise a third material(926). The second and third materials (924B, 926) may comprise anon-magnetic material (e.g., plastic or the like), a magnetic materialcoated with a non-magnetic material, a combination thereof, or the like.

Additionally or alternatively, the magnetic element (912B), the secondmaterial (924B), and the third material (926) need not have the samemass, and it may be desirable to vary the mass of the materials (912B,924B, 926) to achieve better control over the grasper (900B). Forexample, varying the mass in different portions of the grasper may alsovary the gravitational force that may counteract an attractive forcebetween a specific portion of the grasper and the control element.

Additionally or alternatively, as described in more detail herein, insome variations, decreasing the mass of some portions of the grasper(e.g., by removing material) may also decrease the attractive forcebetween that portion and the control element. In some embodiments, thesecond and/or third material (924B, 926) may also comprise magneticelements. In some of these embodiments, the second and/or thirdmaterials (924B, 926) may be materials that experience a repulsive forcewhen exposed to the control element (916). It should be appreciated thatthe second and third materials (924B, 926) need not be in the locationsor proportions indicated in FIG. 9B, and may instead have any locationsand proportions that facilitate maneuvering the grasper (900B) with thecontrol element (916).

FIG. 9C depicts the grasper (900A) of FIG. 9A in use with a controlelement (916) comprising a longitudinal axis (920). A cross-sectionalside view of the cavity wall (922) can also be seen, with the grasper(900A) located within the body, and the control element (916) locatedoutside of the body. The attractive force between the control element(916) and the magnetic element (912A) may move the proximal end (910A)of the grasper (900A) towards the control element (916). The grasper(900A) may then be in a similar perpendicular position to that describedwith respect to FIG. 8B. In variations in which a proximal portion ofthe grasper (900A) comprises a material that is repelled by the controlelement (916), the repulsive force may also contribute to the movementof the grasper (900A) and may aid in positioning the grasper (900A) inthe perpendicular configuration.

Likewise, in some surgical procedures, it may be desirable for thegrasper to move to and/or be held such that its longitudinal axis liesparallel to the cavity wall. FIG. 10A depicts a cross-sectional sideview of a variation of a grasper (1000) configured to be used with acontrol element located outside of the body to place the grasper in aparallel configuration. FIGS. 10B and 10C depict variations of a systemcomprising a control element (1016, 1026) and the grasper (1000) of FIG.10A in a parallel configuration. FIG. 10A depicts a variation of agrasper (1000) comprising a first jaw (1002), a second jaw (1004), amain body (1006), a proximal end (1010), a distal end (1008), alongitudinal axis (1014) and a magnetic element (1012). In somevariations, the magnetic element (1012) may have north and south poles.The north and south poles may be oriented along the axial length of thegrasper (1000) (i.e., along its longitudinal axis (1014)). The remainderof the grasper (1000) (aside from the magnetic element (1012))including, for example, the remainder of the main body (1006) and thefirst and second jaws (1002, 1004), may comprise a non-magneticmaterial, ferromagnetic material, ferrimagnetic material, a combinationthereof, or the like. In some instances, the grasper (1000) may comprisea second magnetic element in a portion of the remainder of the grasper(1000) that may comprise a material that experiences a repulsive forcewhen exposed to a magnetic field generated by the control element (1016,1026) (e.g., a diamagnetic material).

The grasper (1000) depicted in FIGS. 10A-10C may comprise a magneticelement (1012) in the form of a magnet positioned axially along thelength of the grasper (1000). The magnetic element (1012) has a northpole and a south pole and is oriented such that its north and southpoles face the proximal and distal ends (1010, 1008) of the grasper(1000), respectively. FIG. 10B depicts a system comprising the grasper(1000) depicted in FIG. 10A and a control element (1016) comprising alongitudinal axis (1020) and a magnetic element (1024). As shown, themagnetic element (1024) in the control element (1016) may comprise amagnet having north and south poles. The north and south poles may bepositioned along the longitudinal axis (1020) of the control element(1026). In the configuration shown, the south pole faces the proximalend of the control element (1016) (i.e., the left side as depicted inFIG. 10B) and the north pole faces the distal end of the control element(1016) (i.e., the right side as depicted in FIG. 10B).

In use, the attractive force between the control element (1016) and themagnetic element (1012) may move the grasper (1000) toward the controlelement (1016) such that the longitudinal axis (1014) of the grasper issubstantially parallel to the longitudinal axis (1020) of the controlelement. More specifically, the north and south poles of the magneticelement (1012) in the grasper (1000) may be attracted to the south andnorth poles, respectively, of the magnetic element (1024) in the controlelement (1016). In this variation, the magnetic element (1012) of thegrasper (1000) is of a sufficient length, or is spread along the grasperacross a sufficient length, to cause both the proximal and distal ends(1010, 1008) of the grasper (1000) to be drawn to the control element(1016) and the cavity wall (1022). In this configuration, thelongitudinal axis (1014) of the grasper (1000) may be substantiallyparallel to both the longitudinal axis (1020) of the surface of thecavity wall such that the first and second jaws (1002, 1004) are nearthe cavity wall. Once in the parallel configuration, the direction ofthe jaws may be manipulated by rotating the control element, which mayin turn cause rotation of the magnetic element (1012) in the grasper(1000). Additionally, if the control element (1016) is moved relative tothe cavity wall (1022) (e.g., moving the control element (1016) alongthe exterior of the body), the grasper (1000) may be moved relative tothe cavity wall by a corresponding amount by the attractive forcesbetween the magnetic element (1024) and the control element (1012).

FIG. 10C depicts another variation of a system for grasping tissuecomprising the grasper (1000) depicted in FIG. 10A and a control element(1026). In this variation, the control element (1026) may comprise afirst magnetic element (1028) and a second magnetic element (1030). Asshown there, the first and second magnetic elements (1028, 1030) may bemagnets having north and south poles. The first and second magneticelements (1028, 1030) may be oriented such that their poles areperpendicular to the longitudinal axis (1020) of the control element(1016) and the cavity wall (1024), and have opposite polarities.

For example, as shown in FIG. 10C, the first magnetic element (1028) maybe oriented such that its north pole is anteriorly positioned and itssouth pole is posteriorly positioned, while the second magnetic element(1030) may be oriented so that its north pole is posteriorly positionedand its south pole is anteriorly positioned. In use, the first magneticelement (1028) may attract the north pole of the magnetic element (1012)of the grasper (1000) and the second magnetic element (1030) may attractthe south pole of the magnetic element (1012) of the grasper (1000).Additionally, if the control element (1026) is moved or rotated relativeto the cavity wall (1022) (e.g., moving or rotating the control element(1026) along the exterior of the body), the grasper (1000) may be movedor rotated relative to the cavity wall by a corresponding amount by theattractive forces between the magnetic elements (1028, 1030) and thecontrol element (1012).

It should be appreciated that the configurations of the magneticelements (1012, 1028, 1030) may be modified. For example, the poles ofthe first and second magnetic elements (1028, 1030) and the magneticelement (1012) of the grasper (1000) may be rotated such that they facethe opposite direction (e.g., the north pole of the first magneticelement (1028) may be posteriorly positioned and the north pole of thesecond magnetic element (1030) may be anteriorly positioned). Themagnetic elements (1012, 1028, 1030) may have any suitable shape, andneed not be cylinders as depicted.

In some embodiments, the grasper and/or the control element may comprisemagnetic elements that have poles that are perpendicular to thelongitudinal axis of the grasper and the control element, but areparallel to the surface of the cavity wall. For example, FIGS. 11A-11Cdepict a variation of a system (with like elements labeled as above)comprising a grasper (1100) and a control element (1116), eachcomprising a magnetic element (1112, 1124). In this variation, themagnetic elements (1112, 1124) may comprise magnets having a north poleand a south pole. The magnetic elements (1112, 1124) may be positionedwithin the grasper (1100) and the control element (1116) so that theirpoles am perpendicular to the longitudinal axis of the grasper (1100)and the control element (1116) respectively, and are parallel to thecavity wall (1122).

FIG. 11C may more clearly depict the orientation of the magneticelements (1112, 1124) in the grasper (1100) and the control element(1116). Shown there is a view from within a patient with a grasper(1100) within the body cavity, and the control element (1116), indicatedby dashed lines, outside of the body and above the cavity wall (1122).In use, the north pole of the magnetic element (1112) of the grasper maybe attracted to the south pole of the magnetic element (1124) of thecontrol element (1116), which may pull or otherwise move the grasper(1100) toward, and substantially parallel to, the cavity wall (1122).

For example, as depicted in FIG. 11C, if the longitudinal axis (1120) ofthe control element (1116) is placed along the longitudinal midline of apatient, the north pole of the magnetic element (1124) of the controlelement (1116) may face the right side of the patient and the south poleof the magnetic element (1124) of the control element (1116) may facethe left side of the patient, or vice versa. In this orientation, thenorth and south poles of the magnetic element (1112) of the grasper(1100) may be attracted to the south and north poles of the magneticelement (1124) of the control element (1116) respectively, which maybring the grasper (1100) into a parallel configuration. While in theparallel configuration, the grasper (1100) may be in a first orientationin which its proximal end (1110) faces a first direction and its distalend (1108) faces a second direction.

The grasper (1100) may be rotated while remaining in the parallelconfiguration by rotating the control element (1116). For example, thegrasper (1100) may be rotated by 180 degrees to place it in a secondorientation in which its proximal end (1110) faces the second directionand its distal end (1108) faces the first direction. It should beappreciated that the grasper (1100) may be rotated by any desired anglewhile remaining in the parallel configuration by rotating the controlelement (1116). Additionally, if the control element (1116) is movedrelative to the cavity wall (1122) (e.g., moving the control element(1116) along the exterior of the body), the grasper (1100) may be movedrelative to the cavity wall by a corresponding amount by the attractiveforces between the magnetic element (1112) and the control element(1116).

It should be appreciated that a visualization device such as a cameraand/or light source may also have a similar configuration of magneticelements as described with respect to graspers in FIGS. 8A-11C. Forexample, a visualization device having a similar configuration ofmagnetic elements as grasper (800) may be used with a control element(816) similar to as shown in FIGS. 8A-8B in order to hold and/or move avisualization device in a perpendicular or angled configuration withrespect to the control element and/or the wall of a patient's bodycavity. For example, a visualization device may comprise a magneticelement comprising a magnet with north and south poles oriented axiallywithin the visualization device, such that the poles are positionedalong a longitudinal axis of the visualization device, as describedabove with respect to grasper (800). Control element (816) may then beused to control the position and/or movement of the visualization devicesimilarly as described with respect to the grasper (800). As anotherexample, a visualization device having similar configuration of magneticelements as grasper (1000) and may be used with a control element (1000)similar to as shown in FIGS. 10A-10B in order to hold and/or move thevisualization device in a parallel configuration, as described in moredetail with respect to grasper (1000).

As mentioned above, in some variations, the grasper may comprise morethan one magnetic element. A visualization device (e.g., camera, lightsource) may similarly comprise more than one magnetic element. Using agrasper (or visualization device) with multiple magnetic elements mayprovide more control over the movement of the grasper, especially withrespect to relative locations of the proximal and distal ends of thegrasper (or visualization device). For instance, utilizing a grasper (orvisualization device) with multiple magnets may make it easier to rotatethe distal end of the grasper (or visualization device) relative to itsproximal end and may allow for better control over the grasper (orvisualization device) once it is in the parallel configuration.Additionally, employing a grasper (or visualization device) withmultiple magnetic elements may make it easier to attract the proximaland/or distal end of the grasper (or visualization device) to thecontrol element (e.g., by repelling the opposite end) and/or control theangle at which the grasper (or visualization device) approaches thecontrol element and/or tissue (e.g., perpendicular, parallel, any anglebetween perpendicular and parallel).

FIGS. 12A-12C depict a variation of the systems described herecomprising a grasper (1200) with two magnetic elements (1212, 1232) anda control element (1206). As shown there, the grasper (1200) maycomprise a first jaw (1202), a second jaw (1204), a main body (1206), aproximal end (1210), a distal end (1208), a longitudinal axis (1214), afirst magnetic element (1212), and a second magnetic element (1232). Thefirst magnetic element (1212) may be located at the proximal end (1210)of the grasper (1200) in the main body (1206), and the second magneticelement (1232) may be located distal to the first magnetic element(1212), for example, in the first jaw (1202). As mentioned above, thefirst and second magnetic elements (1212, 1232) may comprise magnetshaving north and south poles. As shown in FIGS. 12A and 12B, the firstand second magnetic elements (1212, 1232) may be oriented such that thepoles of the first and second magnetic elements (1212, 1232) may besubstantially perpendicular to the longitudinal axis (1214) of thegrasper (1200) and the cavity wall (1222). For example, the poles of themagnetic elements (1212, 1232) may face posteriorly (toward the cavitywall (1222)) and anteriorly (away from the cavity wall (1222)) when thelongitudinal axis (1214) of the grasper (1200) is substantially parallelto the longitudinal axis of a patient.

The first and second magnetic elements (1212, 1232) may be located atany suitable place on or within the grasper (1200), and need not belocated as depicted. However, in some instances, it may be desirable toplace the first and second magnetic elements (1212, 1232) as close tothe proximal and distal ends (1210, 1208) of the grasper as possible, asdoing so may assist in steering or otherwise controlling the grasper(1200).

Additionally or alternatively, in instances in which the magneticelements (1212, 1232) may exert forces on each other, placing themfarther away from each other, or with more non-magnetic material betweenthem, may decrease any unwanted effect they may have on each otherand/or on the grasper (1200). The first and second magnetic elements(1212, 1232) may have any suitable cross-sectional shape, for example,circle, square, oval, rectangle, hexagon, and the like, and need notcomprise the same cross-sectional shape.

FIGS. 12B and 12C depict a cross-sectional side view and aninside-the-patient view, respectively, of the grasper (1200) within thebody. The grasper (1200) may be used with a control element (1216) thatalso comprises two magnetic elements including a first magnetic element(1228) and a second magnetic element (1230). The first and secondmagnetic elements (1228, 1230) may be located at the proximal and distalends of the control element (1216) respectively, and the control element(1216) may comprise non-magnetic material between the first and secondmagnetic elements (1228, 1230). In some variations, the poles of thefirst and second magnetic elements (1228, 1230) of the control element(1216) may be perpendicular to the longitudinal axis (1220) of thecontrol element (1216) and the cavity wall (1222). While the magneticelements (1228, 1230) are depicted at the proximal and distal ends ofthe control element (1216), they need not be. The magnetic elements(1228, 1230) may be located anywhere on or within the control element(1216). Alternatively, while the control element (1216) is depicted withtwo magnetic elements (1228, 1230), in some variations, it may onlycomprise one magnetic element.

In use, the opposite poles of the first and second magnetic elements(1212, 1232) in the grasper (1200) and the first and second magneticelements (1228, 1230) in the control element (1216) may be attracted toeach other, respectively, which may place the grasper (1200) in theparallel configuration, as shown in FIGS. 12B and 12C. As depictedthere, the north pole of the first magnetic element (1212) in thegrasper (1200) faces anteriorly (i.e., toward the cavity wall (1222) andthe control element (1216)), and the north pole of the second magneticelement (1232) in the grasper (1200) faces posteriorly (i.e., away fromthe cavity wall (1222) and the control element (1216)). The north poleof the first magnetic element (1228) in the control element (1216) facesanteriorly (i.e., away from the cavity wall (1222)), and the north poleof the second magnetic element (1230) in the control element (1216)faces posteriorly (e.g., toward the cavity wall (1222)). If the controlelement (1216) is moved relative to the cavity wall (1222) (e.g., movingthe control element (1216) along the exterior of the body), the grasper(1200) may be moved relative to the cavity wall by a correspondingamount by the attractive forces between the magnetic element (1212) andthe control element (1216).

While the first and second magnetic elements in both the grasper (1200)and the control element (1216) are depicted with the poles of the firstmagnetic element facing the opposite direction as the poles of thesecond magnetic element, this need not be the case. For example, thefirst and second magnetic elements may be positioned such that the northpoles of both of the magnetic elements face the same direction.

Additionally, while depicted as permanent magnets comprising north andsouth poles, the magnetic elements (1212, 1232) need not be and maycomprise any of the magnetic elements described above that result inattractive forces between the magnetic elements (1212, 1232) in thegrasper (1200) and the magnetic elements (1228, 1230) in the controlelement (1216). For example, in some instances, either (but not both)the magnetic element (1212) in the grasper (1200) or the magneticelement (1228) in the control element (1216) may be a material attractedto a magnetic field but may not generate a magnetic field (e.g., aferrimagnetic or ferromagnetic material); similarly, either (but notboth) the magnetic element (1232) in the grasper (1200) or the magneticelement (1230) in the control element (1216) may be a material attractedto a magnetic field but may not generate a magnetic field (e.g., aferrimagnetic or ferromagnetic material).

FIG. 12D depicts a variation of the systems described here comprising acamera (1250) with two magnetic elements (1262, 1282). As shown there,the camera (1250) may comprise a lens (1252), a main body (1256), aproximal end (1260), a distal end (1258), a longitudinal axis (1264), afirst magnetic element (1262), and a second magnetic element (1282). Itshould be appreciated that the main body of the camera may have anysuitable shape, and that the lens may have any suitable configurationand need not be located at the distal end of the camera (e.g., the lensmay be located along the main body and be facing radially outward). Thefirst magnetic element (1262) may be located at the proximal end (1260)of the camera (1250) in the main body (1256), and the second magneticelement (1282) may be located distal to the first magnetic element(1262), for example, adjacent the lens (1252). The first and secondmagnetic elements (1262, 1282) may comprise magnets having north andsouth poles.

As shown in FIG. 12D, the first and second magnetic elements (1262,1282) may be oriented such that the poles of the first and secondmagnetic elements (1262, 1282) may be substantially perpendicular to thelongitudinal axis (1264) of the camera (1250). The first and secondmagnetic elements (1262, 1282) may be located at any suitable place onor within the camera (1250), and need not be located as depicted.However, in some instances, it may be desirable to place the first andsecond magnetic elements (1262, 1282) as close to the proximal anddistal ends (1260, 1258) of the camera (1250) as possible, as doing somay assist in positioning or otherwise controlling the camera (1250).

Additionally or alternatively, in instances in which the magneticelements (1262, 1282) may exert forces on each other, placing themfarther away from each other, or with more non-magnetic material betweenthem, may decrease any unwanted effect they may have on each otherand/or on the camera (1250). The first and second magnetic elements(1262, 1282) may have any suitable cross-sectional shape, for example,circle, square, oval, rectangle, hexagon, and the like, and need notcomprise the same cross-sectional shape.

Additionally, while depicted as permanent magnets comprising north andsouth poles, the magnetic elements (1262, 1282) need not be and maycomprise any of the magnetic elements described above that result inattractive forces between the magnetic elements (1262, 1282) in thecamera (1250). For example, in some instances, the magnetic elements(1262, 1282) in the camera (1250) may be a material attracted to amagnetic field but may not generate a magnetic field (e.g., aferrimagnetic or ferromagnetic material).

The camera (1250) may be used with a control element in a similar manneras described with respect to grasper (1200) and control element (1216)in FIGS. 12B-12C. For example, camera (1250) may be used with controlelement (1216) such that the opposite poles of the first and secondmagnetic elements (1262, 1282) in the camera (1250) and the first andsecond magnetic elements (1228, 1230) in the control element (1216) maybe attracted to each other, respectively, which may place the camera(1250) in the parallel configuration, similarly to the configuration ofthe grasper (1200) shown in FIGS. 12B and 12C. That is, the north poleof the first magnetic element (1262) in the camera (1250) may faceanteriorly (i.e., toward the cavity wall (1222) and the control element(1216)), and the north pole of the second magnetic element (1282) in thecamera (1250) may face posteriorly (i.e., away from the cavity wall(1222) and the control element (1216)). The north pole of the rustmagnetic element (1228) in the control element (1216) may faceanteriorly (i.e., away from the cavity wall (1222)), and the north poleof the second magnetic element (1230) in the control element (1216) mayface posteriorly (e.g., toward the cavity wall (1222)). If the controlelement (1216) is moved relative to the cavity wall (1222) (e.g., movingthe control element (1216) along the exterior of the body), the camera(1250) may be moved relative to the cavity wall by a correspondingamount by the attractive forces between the magnetic element (1262) andthe control element (1216).

In yet other variations, an orientation of a grasper or visualizationdevice (e.g., camera, light source) may be manipulated by a controlelement located outside of the body. In some variations, the grasper orvisualization device and the control element may be configured to yielda desired change in position and/or orientation of the grasper orvisualization device without movement of the control element relative tothe body. For example, as shown in FIGS. 18A-18B, a control element(1816) and a grasper (1800) may be configured to rotate the grasperbetween a perpendicular configuration (FIG. 18A) and a parallelconfiguration (FIG. 18B) relative to the internal wall of the patient'sbody cavity (1822) and/or the surface of the control element withoutmoving the control element (1816) relative to the body cavity (1822). Asanother example, FIGS. 19A-19B illustrates a 90 degree yaw rotation of agrasper (1900) about an axis perpendicular to the grasper (1900) throughrotation (1930) of a magnetic housing (1924) while the control element(1916) itself remains stationary externally on a patient body cavitywall (1922).

In some surgical procedures, or at times during a surgical procedure, itmay be desirable for the grasper or visualization device to move betweena perpendicular or angled configuration and a substantially parallelconfiguration with respect to the wall of a patient's body cavity (e.g.,an abdominal cavity) through manipulation of a control element. FIG. 18Adepicts a variation of a system comprising a control element (1816) anda grasper (1800) positioned in a perpendicular configuration relative tothe cavity wall (1822). FIG. 18B depicts the grasper (1800) positionedin a substantially parallel configuration relative to the cavity wall(1822).

As shown in FIG. 18A, the grasper (1800) may comprise a first jaw (1802)rotatably coupled to a main body (1806), a second jaw (1804) fixedrelative to the main body (1806), a proximal end (1810), a distal end(1808), and a magnetic element (1812). In this variation, the magneticelement (1812) may be located in or on the main body (1806) at ortowards a proximal end (1810) of the grasper (1800). When the grasper(1800) is exposed to a force generated by control element (1816)comprising a magnet (1824), the proximal end (1810) of the grasper(1800) may be attracted to the control element (1816). The remainder ofthe grasper (1800) (aside from the magnetic element), including, forexample, the remainder of the main body (1806) and the first and secondjaws (1802, 1804), may in some instances comprise a non-magneticmaterial. In other instances, all or a portion of the remainder of themain body (1806) and the first and second jaws (1802, 1804) may comprisea second magnetic element that is ferromagnetic, that experiences arepulsive force when placed close to the control element (1816), forexample, a diamagnetic material (e.g., copper, zinc, lead, and thelike), or that is a permanent magnet having a polarity causing it to berepelled by the control element.

As shown in FIG. 18A, the magnetic element (1812) may comprise a magnetwith north and south poles oriented axially within the grasper (1800)such that the poles are positioned along a longitudinal axis of thegrasper (1800). More particularly, the south pole of the magneticelement (1812) faces a proximal end (1810) of the grasper (1800) and thenorth pole faces a distal end (1808) of the grasper (1800). Shown inFIG. 18A is the grasper (1800) within the body and separated from acontrol element (1816) by the body cavity wall (1822). The controlelement (1816) is provided outside the body and comprises a longitudinalaxis (1820). It should be appreciated that the longitudinal axis (1820)of the control element (1816) need not be substantially parallel to thecavity wall (1822), and may be provided perpendicular to or at an anglerelative to the cavity wall (1822). In other words, the shape of thecontrol element (1816) is not particularly limited. Likewise, the magnet(1824) may have any suitable cross-sectional shape, for example, circle,square, oval, triangle, rectangle, hexagon, and the like.

The control element may comprise a control element housing (1816)enclosing a magnet housing (1824) comprising a magnet. As discussedbelow, the magnet housing (1824) may be rotatable (arrow 1830) relativeto the control element housing (1816). In FIG. 18A, the magnet housing(1824) is positioned relative to the control element housing (1816) in afirst configuration such that the poles of the magnetic material facetoward and away from the cavity wall (1822). As depicted, the north poleof the magnetic material faces downward, or toward the cavity wall(1822), and the south pole of the magnetic material faces upward, oraway from the cavity wall (1822). In some instances, the magnet housing(1824) in this position may be rotated (1830) 90° relative to thecontrol element housing (1816) to orient the magnet housing (1824) in aconfiguration perpendicular to the first configuration where the northand south poles are aligned along a longitudinal axis (1820) of thecontrol element. Of course, the magnet housing (1824) may be rotated(1830) by other amounts, such as shown in FIG. 18B as discussed infurther detail below.

While the control element housing (1816) is depicted as enclosing themagnet housing (1824), it need not be, so long as the magnet housing(1824) is rotatable relative to the control element housing (1816).Furthermore, while the magnet housing (1824) is depicted as having acircular cross-sectional shape, the magnet housing (1824) may compriseany shape allowing rotation or other reorientation of the magnet housing(1824) relative to the control element housing (1816), in order tochange the magnetic field applied to the grasper (1800). Similarly, themagnetic material within the magnet housing (1824) may comprise anydesirable shape within the magnet housing (1824). In some variations,the magnetic material may be provided without a magnet housing, and themagnetic material may be rotatable relative to the control elementhousing. In some variations, the control element housing (1816) maycomprise a combination of one or more non-magnetic materials (e.g.,plastics, paramagnetic materials such as titanium, and the like) and oneor more magnets.

As depicted in FIG. 18A, the attractive forces between the controlelement in a first position as shown and the magnetic element (1812) maymove the proximal end (1810) of the grasper (1800) toward the controlelement housing (1816). More specifically, the south pole of themagnetic element (1812) in the grasper (1800) may be attracted to thenorth pole of the magnet housing (1824). The attractive forces betweenthe magnetic element (1812) in the grasper (1800) and the controlelement housing (1816) may cause the proximal end (1810) of the grasper(1800) to be attracted to and move toward the control element housing(1816) and the cavity wall (1822), while the distal end (1808) of thegrasper (1800) may be repelled by and move away from the control elementhousing (1816) and the cavity wall (1822). Accordingly, the attractiveforces between the magnetic element (1812) and the control elementhousing (1816) may cause the grasper (1800) to rotate and/or move into aposition in which its longitudinal axis is transverse, and substantiallyperpendicular to, the surface of the cavity wall (1822) and longitudinalaxis (1820) of the control element housing (1816). In this position, thefirst and second jaws (1802, 1804) of the grasper (1800) may be facingaway from the cavity wall (1822).

Instead of the first position, shown in FIG. 18A, it may be desirablefor the grasper (1800) to move to and/or be held in a differentorientation (e.g., such that its longitudinal axis lies parallel to thecavity wall (1822)), as depicted in FIG. 18B. In particular, FIG. 18Bdepicts a second configuration of the magnet housing (1824) where thenorth and south poles are oriented along the longitudinal axis (1820) ofthe control element housing (1816). In the second configuration shown,the north pole of the magnetic element (1812) faces the proximal end ofthe control element housing (1816) (i.e., the left side as depicted inFIG. 18B) and the south pole of the magnetic element (1812) faces thedistal end of the control element housing (1816) (i.e., the right sideas depicted in FIG. 18B).

In the second configuration, the attractive force between the controlelement housing (1816) and the magnetic element (1812) may move thegrasper (1800) toward the control element housing (1816) in a secondposition such that the grasper (1800) may be substantially parallel tothe longitudinal axis (1820) of the control element housing (1816). Morespecifically, the north and south poles of the magnetic element (1812)in the grasper (1800) may be attracted to the south and north poles,respectively, of the magnet in the magnet housing (1824). As such, asthe magnet housing (1824) of the control element housing (1816) isrotated from a first configuration (FIG. 18A) to the secondconfiguration (FIG. 18B), the change in the magnetic field will likewiserotate the grasper (1800) from a first position perpendicular to thecavity wall (1822) to a second position parallel to the cavity wall(1822).

It should be appreciated that the grasper (1800), the magnetic element(1812), and the control element housing (1816) may be configured suchthat the attractive forces between the magnetic element (1812) and thecontrol element housing (1816) cause the grasper (1800) to rotate and/ormove into a position in which the longitudinal axis of the grasper(1800) is located at an angle that is less than 90 degrees with respectto the surface of the cavity wall (1822) due to factors such as theorientation and strength of the magnetic elements in the grasper (1800)and the control element housing (1816), the material of the grasper(1800), gravity, and/or the tension force from organs or other tissueheld by the grasper (1800). The grasper (1800) and the control elementhousing (1816) may be configured to have an attractive force betweenthem that places the grasper (1800) in a desired angular orientationconsidering these variables.

It should further be appreciated that a change in configuration of agrasper may be provided through a combination of manipulation of theentire control element housing (1816) relative to the grasper and of amagnet relative to the control element housing.

As another example, FIG. 18C depicts a variation of a system comprisinga control element (1816) and a visualization device comprising a camera(1850) positioned in a perpendicular configuration relative to thecavity wall (1822). FIG. 18B depicts the camera (1850) positioned in asubstantially parallel configuration relative to the cavity wall (1822).

As shown in FIGS. 18C-181D, camera (1850) may comprise a lens (1852)coupled to a main body (1856), a proximal end (1860), a distal end(1858), and a magnetic element (1862). In this variation, the magneticelement (1862) may be located in or on the main body (1856) at ortowards a proximal end (1860) of the camera (1850). It should beappreciated that the main body of the camera may have any suitableshape, and that the lens may have any suitable configuration and neednot be located at the distal end of the camera (e.g., the lens may belocated along the main body and be facing radially outward). When thecamera (1850) is exposed to a force generated by control element (1816)as described above, the proximal end (1860) of the camera (1850) may beattracted to the control element (1816). The remainder of the camera(1850) (aside from the magnetic element), including, for example, theremainder of the main body (1856) and the lens 1852), may in someinstances comprise a non-magnetic material. In other instances, all or aportion of the remainder of the main body (1856) may comprise a secondmagnetic element that is ferromagnetic, or that is a permanent magnet asdescribed.

As shown in FIG. 18C, the magnetic element (1862) may comprise a magnetwith north and south poles oriented axially within the camera (1850)such that the poles are positioned along a longitudinal axis of thecamera (1850). More particularly, the south pole of the magnetic element(1862) faces a proximal end (1860) of the camera (1850) and the northpole faces a distal end (1858) of the camera (1850). Shown in FIG. 18Cis the camera (1850) within the body and separated from a controlelement (1816) by the body cavity wall (1822). It should be noted thatdescription of the structure and operation of control element (1816) inFIGS. 18C and 18D is similar to FIGS. 18A and 18B and is omitted for thesake of brevity.

As depicted in FIG. 18C, the attractive forces between the controlelement in a first position as shown and the magnetic element (1862) maymove the proximal end (1860) of the camera (1850) toward the controlelement housing (1816). More specifically, the south pole of themagnetic element (1862) in the camera (1850) may be attracted to thenorth pole of the magnet housing (1824). The attractive forces betweenthe magnetic element (1862) in the camera (1850) and the control elementhousing (1816) may cause the proximal end (1860) of the camera (1850) tobe attracted to and move toward the control element housing (1816) andthe cavity wall (1822), while the distal end (1858) of the camera (1850)may be repelled by and move away from the control element housing (1816)and the cavity wall (1822). Accordingly, the attractive forces betweenthe magnetic element (1862) and the control element housing (1816) maycause the camera (1850) to rotate and/or move into a position in whichits longitudinal axis is transverse, and substantially perpendicular to,the surface of the cavity wall (1822) and longitudinal axis (1820) ofthe control element housing (1816). In this position, the lens (1852) ofthe camera (1850) may be facing away from the cavity wall (1822).

Instead of the first position, shown in FIG. 18C, it may be desirablefor the camera (1850) to move to and/or be held in a differentorientation (e.g., such that its longitudinal axis lies parallel to thecavity wall (1822)), as depicted in FIG. 18D. In particular, FIG. 18Ddepicts a second configuration of the magnet housing (1824) where thenorth and south poles are oriented along the longitudinal axis (1820) ofthe control element housing (1816). In the second configuration shown,the north pole of the magnetic element (1862) faces the proximal end ofthe control element housing (1816) (i.e., the left side as depicted inFIG. 18D) and the south pole of the magnetic element (1812) faces thedistal end of the control element housing (1816) (i.e., the right sideas depicted in FIG. 18D).

In the second configuration, the attractive force between the controlelement housing (1816) and the magnetic element (1862) may move thecamera (1850) toward the control element housing (1816) in a secondposition such that the camera (1850) may be substantially parallel tothe longitudinal axis (1820) of the control element housing (1816). Morespecifically, the north and south poles of the magnetic element (1862)in the camera (1850) may be attracted to the south and north poles,respectively, of the magnet in the magnet housing (1824). As such, asthe magnet housing (1824) of the control element housing (1816) isrotated from a first configuration (FIG. 18C) to the secondconfiguration (FIG. 18D), the change in the magnetic field will likewiserotate the camera (1850) from a first position perpendicular to thecavity wall (1822) to a second position parallel to the cavity wall(1822).

It should be appreciated that the camera (1850), the magnetic element(1862), and the control element housing (1816) may be configured suchthat the attractive forces between the magnetic element (1862) and thecontrol element housing (1816) cause the camera (1850) to rotate and/ormove into a position in which the longitudinal axis of the camera (1850)is located at an angle that is less than 90 degrees with respect to thesurface of the cavity wall (1822) due to factors such as the orientationand strength of the magnetic elements in the camera (1850) and thecontrol element housing (1816), the material of the camera (1850),gravity, and/or the force from organs or other tissue abutting thecamera (1850). The camera (1850) and the control element housing (1816)may be configured to have an attractive force between them that placesthe camera (1850) in a desired angular orientation considering thesevariables.

It should further be appreciated that a change in configuration of avisualization device may be provided through a combination ofmanipulation of the entire control element housing relative to thevisualization device and of a magnet relative to the control elementhousing.

In some variations, the grasper and/or the control element may comprisemagnetic elements that have poles that are perpendicular to thelongitudinal axis of the grasper and the control element (as shown inFIGS. 19A-19B). In these variations, the grasper and the control elementmay be configured to yield a desired change in position and/or rotationof the grasper. For example, in some instances, the control element andthe grasper may be configured such that the control element can causethe grasper to rotate about an axis perpendicular to a cavity wall toprovide the grasper yaw rotation where, for example, the graspermaintains a parallel configuration relative to the internal wall of thepatient's body cavity or the surface of the control element. In otherinstances, the control element may be configured to cause roll rotationof the grasper about the longitudinal axis of the grasper while thegrasper is perpendicular to the cavity wall.

For example, FIGS. 19A-19B depict a variation of a system comprising agrasper (1900) comprising a magnetic element (1912). The control elementmay comprise a control element housing (1916) enclosing a magnet housing(1924) comprising a magnet. In this variation, the magnetic element(1912) and magnet housing (1924) may each comprise magnets each having anorth pole and a south pole. The magnetic element (1912) and magnethousing (1924) may be positioned within the grasper (1900) and thecontrol element housing (1916), respectively, so that their poles areperpendicular to the longitudinal axis (1920) of the grasper (1900) andthe control element housing (1916) respectively. As shown in FIGS.19A-19B, the grasper and control element may be placed such that thepoles are parallel to the cavity wall (1922).

FIG. 19A depicts the orientation of the magnetic element (1912) andmagnet housing (1924) in the grasper (1900) and the control elementhousing (1916), respectively. Shown there is a view from within apatient's body cavity. Grasper (1900) is shown within the body cavity,and the control element housing (1916), indicated by dashed lines, isshown outside of the body and above the cavity wall (1922). In use, thenorth pole of the magnetic element (1912) of the grasper may beattracted to the south pole of the magnet housing (1924) of the controlelement housing (1916), which may pull or otherwise move the grasper(1900) toward, and substantially parallel to, the cavity wall (1922).

For example, as depicted in FIG. 19A, if the longitudinal axis (1920) ofthe control element housing (1916) is placed along the longitudinalmidline of a patient, the north pole of the magnet housing (1924) of thecontrol element housing (1916) may face the right side of the patientand the south pole of the magnet housing (1924) of the control elementhousing (1916) may face the left side of the patient, or vice versa. Inthis orientation, the north and south poles of the magnet housing (1912)of the grasper (1900) may be attracted to the south and north poles ofthe magnet housing (1924) of the control element housing (1916)respectively, which may bring the grasper (1900) into a parallelconfiguration.

While in the parallel configuration, the grasper (1900) may be in afirst orientation in which its proximal end (1910) faces a firstdirection and its distal end (1908) faces a second direction. Thegrasper (1900) may be rotated while remaining in the parallelconfiguration by rotating (arrow 1930) magnet (1924) relative to thecontrol element housing (1916). For example, the grasper (1900) may berotated by 180 degrees to place it in a second orientation in which itsproximal end (1910) faces the second direction and its distal end (1908)faces the first direction.

As another example, FIG. 19B illustrates the grasper (1900) rotated(1930) by 90 degrees by rotation of the magnet housing (1924) relativeto the control element housing (1916) such that the longitudinal axis ofthe grasper (1900) is perpendicular to the longitudinal axis (1920) ofthe control element housing (1916). It should be appreciated that thegrasper (1900) may be rotated by any desired angle while remaining inthe substantially parallel configuration by rotating the magnet housing(1924) relative to the control element housing (1916). Furthermore, themagnet housing (1924) and control element housing (1916) need not havethe cross-sectional shapes as depicted in FIGS. 19A-19B, and may haveany configuration that allows rotation of the magnet relative to thecontrol element.

It should be appreciated that a visualization device (e.g., camera,light source) and/or control element may also have a similarconfiguration of magnetic elements as described with respect to thegraspers and control elements in FIGS. 19A-19B. In some variations, thevisualization device and/or the control element may comprise magneticelements that have poles that are perpendicular to the longitudinal axisof the visualization device and the control element similar to as shownin FIGS. 19A-19B. In these variations, the visualization device and thecontrol element may be configured to yield a desired change in positionand/or rotation of the visualization device. For example, in someinstances, the control element and the visualization device may beconfigured such that the control element can cause the visualizationdevice to rotate about an axis perpendicular to a cavity wall to providethe visualization device yaw rotation where, for example, thevisualization device maintains a parallel configuration relative to theinternal wall of the patient's body cavity or the surface of the controlelement. In other instances, the control element may be configured tocause roll rotation of the visualization device about the longitudinalaxis of the visualization device while the visualization device isperpendicular to the cavity wall.

FIG. 20 depicts an illustrative variation of a control element providinga variable magnetic field. The control element (2000) comprises a magnetthat rotates relative to the control element housing such that thecontrol element may be stationary as the magnetic field applied to agrasper is modified. A control element (2000) may comprise a controlelement housing (2002) enclosing a magnet housing (2012) comprising amagnet (2010) and a magnet control (2014). Movement of the magnetcontrol (2014) within a control element opening (2004) may providecorresponding rotation of the magnet housing (2012) and in turn themagnet (2010). The magnet (2010) may comprise a diamagnetic material andmay comprise opposing north and south poles. The control element housing(2002) may have one or more openings that define a range of motion ofthe magnet control (2014). In FIG. 20 , movement of the magnet control(2014) through its range of motion will rotate the magnet (2010) by 90degrees to change the direction of the poles.

It should be appreciated that one or more of the magnet (2010) andmagnet housing (2012) may comprise a sphere, bar, axially-magnetizedcylinder, or a set of magnets. The magnet (2010) illustrated in FIG. 20may be rotated about a longitudinal axis of the control element (2000).In other variations, the poles may be oriented axially within thecontrol element (2000) such that the poles are positioned along alongitudinal axis of the control element (2000). In still othervariations, the magnet (2010) may have additional degrees of freedom.For instance, the magnet housing (2012) may be spherical and the magnetcontrol (2014) may be manipulated to provide three degrees of freedom.If the control element opening (2004) is spherical for example, then themagnet control (2014) may be manipulated like a joystick. It should beappreciated that the magnet housing (2012) and control element housing(2002) may comprise different shapes and/or materials. The magnet (2010)and magnet housing (2012) may comprise any shape that allows rotationand/or movement relative to the control element (2000).

While the variation of the grasper that is described above with respectto FIGS. 6A-6D and FIGS. 7A-7D is depicted in FIGS. 8A-12C, 18A-18B, and19A-19B, it should be appreciated that any suitable grasper,visualization device, and/or delivery systems described here may beconfigured with magnetic and non-magnetic materials as described inFIGS. 8A-12D and 18A-19B. Additionally, it should be appreciated thatthe magnetic and non-magnetic materials described with respect to FIGS.8A-12D and 18A-19B may be designed to work concurrently with thedelivery devices described above, and in some variations, the couplingmagnet and the magnetic element may comprise the same material and/or bethe same magnet.

II. Methods

The graspers, visualization devices (e.g., cameras, light sources), andsystems described herein may be used in minimally invasive procedures.These may include any suitable minimally invasive procedure, such as butnot limited to abdominal procedures, thorascopic procedures, bariatricprocedures, or urological/gynecological procedures. Generally, asmentioned above, to provide suspension of tissue, a grasper as describedherein may be advanced into the body, may be releasably connected to atissue in the body, and may be suspended using one or more magneticelements positioned externally to the body to move and suspend thetissue. In some variations, the connection between the grasper and thetissue may be released, and the grasper may be repositioned andreconnected to tissue (either the same tissue or different tissue). Insome variations, to provide visualization of a surgical procedure from adesired position and orientation within a body cavity, a visualizationdevice such as a camera and/or light source as described herein may beadvanced into the body, and may be suspended using one or more magneticelements positioned externally to the body.

The grasper may be advanced into the body in any suitable manner. Insome variations, the grasper may be advanced into the body through aport as part of a minimally invasive procedure. In some instances, theminimally invasive procedure may be a reduced port technique orsingle-incision procedure. In some variations, the grasper may beadvanced into the body using a delivery device, such as the deliverydevice (100) described above with respect to FIGS. 1A-1C and 2A-2F. Inthese variations, the grasper may be releasably coupled to a distalengagement portion of the delivery device, and the distal engagementportion of the delivery device may be advanced into the body to advanceand position the grasper within the body.

Once the grasper is positioned in the body, it may be releasablyconnected to tissue. To connect the grasper to tissue, the grasper mayfirst be placed in an open configuration, in which a first jaw of thegrasper is rotated away from a second jaw of the grasper. In somevariations, the grasper may be placed in an open configuration using thedelivery device carrying the grasper (e.g., by advancing an actuationrod through a barrel portion of the grasper, such as described in moredetail above with respect to FIGS. 2A-2F) or by a grasping device whichmay engage and move the grasper to the open configuration (as describedin more detail above). With the grasper in the open configuration, thegrasper may be manipulated to position the tissue between the first jawand the second jaw. The grasper may be returned to a closedconfiguration, in which the first jaw rotates toward the second jaw tohold the tissue between the jaws. The grasper may then be released fromthe delivery device and/or grasping device, and these devices may beremoved from the body.

With the grasper releasably connected to the tissue (either by grippingthe tissue or by capturing it in a space between the jaws), a controlelement comprising one or more magnetic elements, as described above,may be positioned externally of the body and may attract and/or repulsethe grasper to reposition and/or hold the grasper. For example, FIGS.5A-5D depict an illustrative method by which a grasper (200) may be usedto reposition and/or hold tissue. While the variations of the grasper(200) and the delivery device (100) that are described above withrespect to FIGS. 1A-1C and 2A-2F are depicted in FIGS. 5A-5D, it shouldbe appreciated that any suitable graspers, and/or delivery systems asdescribed here may perform the steps discussed below. Specifically, asshown in FIG. 5A, the grasper (200) may be advanced into the body towarda target tissue (502) (shown in FIG. 5 as a gallbladder, although itshould be appreciated that the graspers described here may be releasablyconnected to any suitable tissue), and positioned in an openconfiguration. To advance the grasper (200), the grasper (200) may bereleasably coupled to a distal engagement portion (108) of a deliverydevice (100), and a user may advance the distal engagement portion (108)into the body to position the grasper (200). The tissue (502) may bepositioned between the first jaw (202) and second (204) jaw of thegrasper (200), and the grasper (200) may be moved to a closedconfiguration to releasably couple the grasper (200) to the tissue(502), as shown in FIG. 5B. Once connected to the tissue (502), thegrasper (200) may be released from the delivery device (100), and thedelivery device (100) may be removed from the body.

As described above with respect to FIGS. 8A-12C and shown in FIG. 5C, acontrol element (500) may be positioned externally of the body (e.g.,cavity wall (504) and may attract the grasper (200) and lift the graspertoward the control element (500). When the grasper (200) is placed inthe abdomen, this may lift the grasper toward the cavity wall (504). Thecontrol element (500) may be further manipulated (e.g., moved axially,laterally, and/or rotated) to reposition the grasper (200) and thetissue (502). In some variations, as shown in FIGS. 18A-18B. 19A-19B,and 20, a magnet of a control element may be manipulated (e.g., using amagnet control) to rotate and/or reposition the grasper and withoutmoving the control element. For example, the grasper may be rotate inone or more of pitch, yaw, and roll through manipulation of the magnetrelative to the control element.

As mentioned above, in some instances it may be desirable to release theconnection between the grasper (200) and the tissue (502). For example,in some instances it may be desirable to connect the grasper to adifferent portion of the tissue (502). In these instances, the grasper(200) may be returned to an open configuration (either using one of thedelivery devices described here or a grasping device, as discussedabove) to release the grasper (200) from the tissue (502). For example,FIG. 5D shows a grasping device (506) having opposing jaws (508) whichmay grab a proximal arm (220) and the main body (206) of the grasper(200) to rotate the first jaw (202) away from the second jaw (204),which may release the tissue (502) from the grasper (200). The grasper(200) may be repositioned to again place the tissue (502) between thejaws (202, 204) of the grasper (200), and the grasper (200) may then beplaced in the closed configuration to reconnect the grasper (200) to thetissue (502). In some variations, the grasper may release the tissue, berepositioned at a second tissue, and may then be placed in the closedconfiguration to connect to the second tissue. In other instances, thegrasper (200) may be decoupled from the tissue, and removed from thebody.

In some variations, a visualization device comprising a camera (550) maybe advanced into the body with a lens (552) directed towards a targettissue (502) (shown in FIG. 5E as a gallbladder, although it should beappreciated that the cameras described here may image any tissue). Toadvance the camera (550), the camera (550) may be releasably coupled toa distal engagement portion of a delivery device, and a user may advancethe distal engagement portion into the body to position the camera(550). Once in position, the camera (550) may be released from thedelivery device, and the delivery device may be removed from the body.

As shown in FIG. 5E, a control element (500) may be positionedexternally of the body (e.g., cavity wall (504)) and may attract thecamera (550) and lift the camera (550) toward the control element (500).When the camera (550) is placed in the abdomen, this may lift the camera(550) toward the cavity wall (504). The control element (500) may befurther manipulated (e.g., moved axially, laterally, and/or rotated) toreposition the camera (550). In some variations, as shown in FIGS.18C-18D and 20 , a magnet of a control element may be manipulated (e.g.,using a magnet control) to rotate and/or reposition the camera (550)without moving the control element. For example, the camera (550) may berotated in one or more of pitch, yaw, and roll through manipulation ofthe magnet relative to the control element.

Some methods may involve the delivery of two or mom graspers asdescribed herein. For example, a first grasper may be advanced into thebody through a port using a delivery device, releasably connected totissue (either by gripping the tissue or by capturing it in a spacebetween the jaws), and released from the delivery device. A firstcontrol element may then be positioned externally of the body to attractand lift the first grasper toward the first control element. A secondgrasper may be advanced into the body through the same port (or a secondport) using the same delivery device (or a second delivery device),releasably connected to tissue (either by gripping the tissue or bycapturing it in a space between the jaws), and released from thedelivery device. A second control element may then be positionedexternally to the body to attract and lift the second grasper toward thesecond control element.

It may in some variations be desirable to have a linkage connected toboth the first and second control elements to prevent the magneticfields generated by the control elements from affecting their relativepositions. FIG. 17 . illustrates an exemplary resulting configuration,with a first grasper (1702) positioned approximately perpendicular to anabdominal wall (1700) and attracted by a first control element (1706),and a second grasper (1704) positioned approximately perpendicular tothe abdominal wall and attracted by a second control element (1708),with the first and second control elements (1706, 1708) connected by alinkage (1710). The first and second graspers (1702, 1704) may each holdtissue within a respective space (1712, 1714) between the two jaws ofthe graspers. As shown, the graspers (1702, 1704) may each holddifferent portions of the same tissue (1716) (e.g., colon), although itshould be appreciated that the graspers (1702, 1704) may hold distinctpieces of tissue. Similarly, more than two graspers may be used in thesame procedure, such as but not limited to three, four, five, or sixgraspers, or more. In some variations, the methods may comprise deliveryof one or more graspers in combination with one or more additionalinstruments (e.g., one or more visualization devices such as cameraand/or light source), delivery of two or more visualization devices, orthe like. For example, in combination with advancement of a firstgrasper as described above, a camera may be advanced into the bodythrough a port using a delivery device and released from the deliverydevice. A control element may then be positioned externally of the bodyto attract and lift the camera toward the first control element.

While the inventive devices, systems, and methods have been described insome detail by way of illustration, such illustration is for purposes ofclarity of understanding only. It will be readily apparent to those ofordinary skill in the art in light of the teachings herein that certainchanges and modifications may be made thereto without departing from thespirit and scope of the appended claims.

We claim:
 1. A method for performing a surgical procedure, comprising:grasping tissue in a grasper; magnetically attracting the grasper to acontrol element across an abdominal wall; and repositioning the graspedtissue by manipulating a magnetic element of the control element tomanipulate the grasper wherein manipulating the magnetic element of thecontrol element comprises rotating the magnetic element relative to thecontrol element, and the grasper is configured to rotate with threedegrees of freedom in response to manipulation by the magnetic element.2. The method of claim 1, wherein the control element remains stationaryrelative to the abdominal wall while rotating the magnetic element. 3.The method of claim 1, further comprising aligning a longitudinal axisof the grasper substantially transverse to a longitudinal axis of thecontrol element by rotating the magnetic element relative to the controlelement.
 4. The method of claim 3, wherein the grasper is configured torotate by a desired angle while remaining substantially transverse tothe longitudinal axis of the control element.
 5. The method of claim 1,further comprising aligning a longitudinal axis of the graspersubstantially parallel to a longitudinal axis of the control element byrotating the magnetic element relative to the control element.
 6. Themethod of claim 5, wherein the grasper is configured to rotate by adesired angle while remaining substantially parallel to the longitudinalaxis of the control element.
 7. The method of claim 1, furthercomprising releasing the grasped tissue by actuating the grasper with adelivery device.
 8. The method of claim 1, wherein manipulating amagnetic element of the control element to manipulate the graspercomprises adjusting an attractive force between a magnetic portion ofthe grasper and the magnetic element.
 9. The method of claim 1, whereinthe grasper comprises a magnetic portion.
 10. The method of claim 9,wherein the magnetic portion of the grasper comprises a magnet ormagnetic material.
 11. The method of claim 1, wherein the magneticelement is housed within the control element.
 12. The method of claim 1,wherein the control element comprises a control element housingenclosing a magnetic element housing comprising the magnetic element.13. The method of claim 1, wherein the grasper comprises a firstmagnetic portion and a second magnetic portion, wherein the magneticelement comprises a first magnetic element and a second magneticelement, and wherein the first and second magnetic portions of thegrasper are configured to magnetically couple to the first and secondmagnetic elements of the control element, respectively.
 14. The methodof claim 1, further comprising moving the control element along anexterior surface of the abdominal wall to reposition the grasperrelative to the abdominal wall.
 15. The method of claim 1, wherein thegrasper comprises a visualization device.
 16. The method of claim 1,further comprising increasing a distance between the control element andthe abdominal wall to decrease an attractive force between the grasperand the magnetic element.
 17. The method of claim 1, further comprisingplacing a non-magnetic material between the control element and theabdominal wall to decrease an attractive force between the grasper andthe magnetic element.
 18. The method of claim 1, wherein the controlelement remains stationary relative to the abdominal wall while rotatingthe magnetic element.
 19. The method of claim 1, wherein the magneticelement comprises a magnet or magnetic material.
 20. The method of claim1, further comprising: advancing the grasper into a body cavity using adelivery device; and disconnecting the delivery device from the grasper.